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Full text of "U.S. Navy Medicine Volume 69, Number 5 May 1978"

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VADM Willard P. Arentzen, MC, USN 
Surgeon General of the Navy 

RADM R.G.W. Williams, Jr., MC, USN 

Deputy Surgeon General 


Ellen Casselberry 


Virginia M. Novinski 


Nancy R. Keesee 


Contributing Editor-in-Chief: 
CDR C.T. Cloutier (MC) 
Aerospace Medicine: CAPT M.G. Webb 
(MC); Dental Corps: CAPT R.D. Ulrey (DC); 
Education: CAPT S,J. Kreider (MC); Fleet 
Support: LCDR J.D. Schweitzer (MSC); 
Gastroenterology: CAPT D.O. Castell 
(MC); Hospital Corps: HMCM H.A. 
Olszak; Legal: LCDR R.E. Broach 
(JAGC); Marine Corps: CAPT D.R. Hauler 
(MC); Medical Service Corps: CDR R.L. 
Surface (MSC); Naval Reserve: CAPT J.N. 
Rizii (MC. USN); Nephrology: CDR J.D. 
Wallin (MC); Nurse Corps: CAPT P.J. 
Elsass (NC); Occupational Medicine: CAPT 
G.M. Lawton (MC); Preventive Medicine: 
CAPT D.F. Hoeffler (MC); Psychiatry: 
CAPT S.J. Kreider (MC); Research: CAPT 
J. P. Bloom (MC); Submarine Medicine: 
CAPT J.C. Rivera (MC) 

POLtCY: V.S- Navy Medicine is an official publication 
of the Navy Medical Department, published by the Bureau 
of Medicine and Surgery. It disseminates to Navy Medical 
Department personnel official and professional information 
relative to medicine, dentistry, and the altied health sci- 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other governmental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and SuTgery. Although U-S- Navy Medi- 
cine may cite or extract from directives, official authority for 
action should be obtained from the cited reference, 

DISTRIBUTION: U.S. Navy Medicine is distributed to 
active-duty Medical Department personnel via the Standard 
Navy Distribution List. The following distribution is author- 
ized: one copy for each Medical, Dental, Medical Service 
and Nurse Corps officer; one copy for every 10 enlisted 
Medical Department members. Requests to increase or de- 
crease the number of allotted copies should be forwarded to 
U.S. Navy Medicine via the local command. 

CORRESPONDENCE: All correspondence should be 
addressed to: Editor, U.S. Navy Medicine* Department of 
the Navy, Bureau of Medicine and Surgery (Code 0010). 
Washington, D.C. 20372. Telephone: {Area Code 202) 
254-4233, 254-4316, 254-4214; Autovon 294-4253. 294-4316, 
294-4214. Contributions from the field are welcome and will 
be published as space permits, subject to editing and pos- 
sible abridgment. 

The issuance of this publication is approved in accor- 
dance with Department of the Navy Publications and 
Printing Regulations (NAVEXOS P-35). 


Volume 69, Number 5 
May 1978 

1 From the Surgeon General 

2 Department Rounds 

Seven Picked for Flag Rank . . . New MSC Chief . . . Life Support 

7 Notes and Announcements 

In Memoriam . . . Industrial and Occupational Hearing Courses . . . 
Diagnostic Coding . . . American Board Certifications 

9 Policy 

Medical Malpractice Claims 

10 Scholars' Scuttlebutt 

How to Get the Training You Want 

14 Features 

The Nurse Corps: Seventy Years Old, but Young at Heart 

20 Education and Training 

Opportunities for Nurse Corps Officers 

21 Professional 

Factors Contributing to Work-Related Accidents Aboard 

U.S. Navy Ships 

LT M.C. Butler, MSC, USNR 

A. P. Jones, Ph.D. 

LTJ.M. La Rocco, MSC, USN 

24 A Psychiatric Nursing Care Plan: Total Care for the Patient 
in Military Psychiatry 
LCDR D.K. Hoblitzell, NC, USNR 


COVER: LT Maureen F. Clary (USNR) is one of more than 2,500 Navy 

nurses who will be celebrating the Nurse Corps' 70th anniversary this 
month. Nominated by her command for recognition as an outstanding 
representative of the Corps, she is currently assigned to the Neonatal 
Intensive Care Unit at NRMC San Diego. 


From the Surgeon General 

Open Letter to Navy Nurses 

Since its beginning 70 years ago. 
the Nurse Corps has been a vital 
element of the Navy health care 
team. The Corps' growth— not only 
in numbers, but in diversity and 
versatility— makes it a prime exam- 
ple of an organization that has 
evolved to meet the changing needs 
of the society it serves. 

In these times it is imperative 
that we in the Medical Department 
utilize all our resources to the full- 
est, and the Nurse Corps officers 
of 1978 have more than risen to this 

From an original nucleus of 20 
nurses, the Corps has grown to 
more than 2,500 men and women, 
serving in a variety of assignments 
and dedicated to providing the 
highest quality of patient care. As 
this issue of U.S. Navy Medicine 
illustrates, Nurse Corps officers 
today are not only filing the more 
traditional nursing rrles, but also 
are increasingly involved in educat- 
ing patients and planning and pro- 
viding patient care at all levels, in- 
cluding primary care. Current ef- 
forts to relieve Nurse Corps officers 
of the nonprofessional, administra- 
tive tasks with which they have 
been plagued in the recent past will 
enable these officers to use their 
talents more fully in the specialties 
for which they have been prepared. 

In all Nurse Corps planning and 
action, changes in the demography 
of the Corps and changes within 
professional nursing itself must be 
considered. For example, of the ap- 
proximately 2,500 Nurse Corps offi- 
cers on active duty, 21 .5% are male. 
It is imperative that these officers, 
now representing nearly one quar- 

VADM Arentzen 

ter of Corps strength, be fully uti- 
lized in all types of assignment. 

These changes also affect other 
areas, such as education. DOD 
guidance provides that applicants 
with baccalaureate education are 
given priority for commission, and 
64% of Nurse Corps officers cur- 
rently hold a baccalaureate or 
higher degree in nursing. Since the 
quality of nursing care is directly 
related to the professional compe- 
tence of nursing practitioners, con- 
tinuing education is to be encour- 
aged. The Navy Nurse Corps, with 
its Continuing Education Approval 
and Recognition Program, was the 
first federal nursing agency to gain 
American Nurses Association ac- 
creditation as an approver and pro- 
vider of continuing education. This 
program will be used as a model for 

other Corps within the Navy Medi- 
cal Department. 

Adequate staffing remains a 
problem. Although the Nurse Corps 
has remained at or near authorized 
strength during the past few years, 
the demand for professional nursing 
care continues to grow. I consider 
our number of authorized nursing 
billets to be inadequate: although 
we are now at authorized strength, 
we all recognize the need for addi- 
tional Nurse Corps officers. This is a 
paradox to those who measure 
quality patient care only in terms of 
length of patient stay or daily pa- 
tient load, and unfortunately it is 
this kind of quantifiable data that 
determines the allocation of defense 
money. Too seldom is it acknowl- 
edged that the patients remaining 
in our hospitals require specialized 
care and staffing patterns applica- 
ble to a now complicated and so- 
phisticated environment, 

I am aware of the frustrations 
confronting you. I am also aware of 
your accomplishments, and I sin- 
cerely thank you for your commit- 
ment to our patients and to the Navy 
Medical Department, despite the 
problems we all share in these diffi- 
cult times. 

As you enter another year of ser- 
vice, I wish for you continued 
growth and challenge in assuring 
first-rate health care for our Navy 
and Marine Corps family. 


Vice Admiral, Medical Corps 

United States Navy 

Volume 69, May 1978 

Department Rounds 

Seven Picked for Flag Rank 

The Medical Department has 
seven new flag officers — five from 
the Medical Corps (three active- 
duty, two Reserve) and two from the 
Dental Corps (one active-duty, one 

RADM-selectee Stephen Barchet 
(MC), commanding officer of the 
Naval Health Sciences Education 
and Training Command, Bethesda, 
Md., since 1977, also holds the posi- 
tion of Special Assistant to the Sur- 
geon General for Medical Depart- 
ment Education and Training. 

Dr. Barchet was born 25 Oct 1932 
in Annapolis, Md. He attended 
Brown University and completed 
medical school under Navy sponsor- 
ship, receiving his M.D. degree 
from the University of Maryland in 
1956. His graduate medical educa- 
tion included general surgery at 
Naval Hospital Portsmouth, Va.; 
obstetrics and gynecology at Naval 
Hospital Boston; and a pathology 
fellowship at Harvard's Hospital for 
Women. Brookline, Mass. 

Dr. Barchet has served as an 
obstetrician-gynecologist at Navy 
facilities in Naples, Italy; Ports- 
mouth, N.H.; Beaufort, S.C.; and 
Bremerton, Wash. From 1966 to 
1967, he was commander of MIL- 
PHAP Team #2, Quang Nam Prov- 
ince, South Vietnam, and from 1970 
to 1973 he was chairman of obstet- 
rics and gynecology at Naval Hos- 
pital Boston. 

In 1973, Dr. Barchet joined the 
Bureau of Medicine and Surgery, 
serving first as assistant head, and 
later as head, of the Training 
Branch. In 1975 he became Deputy 
Special Assistant to the Surgeon 
General for Medical Department 
Education and Training and sub- 
sequently served for nine months as 
BUMED's physician representative 

on the Chief of Naval Operations' 
Select Committee to Review Navy 
Health Care. From 1976 to 1977, he 
held appointments as associate 
dean of the Uniformed Services 
University of the Health Sciences 
School of Medicine and executive 
secretary of the USUHS Board of 

Dr. Barchet is certified by the 
American Board of Obstetrics and 
Gynecology and holds medical 
school faculty appointments at Bos- 
ton University and The George 
Washington University. He is a fel- 
low of the American College of Ob- 
stetricians and Gynecologists, and 
his memberships include the Inter- 
national Society for the Study of 
Vulvar Diseases, Baker-Channing 
Society, American Medical Associa- 
tion, Association of Military Sur- 
geons of the United States, and 
Society of Medical Consultants to 
the Armed Forces. He is also chair- 
man of the Medical-Dental Com- 
mittee of the Interservice Training 
Review Organization, alternate 
regent to the National Library of 
Medicine Board of Regents, and 
consultant to the National Board of 
Medical Examiners' Panel on Allied 
Health. He holds the Bronze Star 
(Combat V), Meritorious Service 
Medal, Meritorious Unit Commen- 
dation, Republic of Vietnam Merito- 
rious Unit Citation, Republic of 
Vietnam Certificate of Merit (1966 
and 1967), and Republic of Vietnam 
Ministry of Health Certificate of 

RADM-selectee John R. Lukas 

(MC), commanding officer of Naval 
Regional Medical Center Corpus 
Christi since 1974, was born 24 Sep 
1925 in Mercer, Pa. He entered the 
Navy under the V-12 program in 

1943 and was commissioned an 
ensign in 1945. He subsequently 
completed flight training and was 
designated naval aviator in 1946. In 
1947, he was granted early release 
from active duty and returned to 
school, receiving his B.S. degree in 
chemistry from Westminster Col- 
lege in 1950 and his M.D. degree 
from the University of Pittsburgh in 

Commissioned a lieutenant (jun- 
ior grade) in the Naval Reserve, Dr. 
Lukas served a rotating internship 
at Naval Hospital Oakland, followed 
by residency training in obstetrics 
and gynecology at the same hos- 
pital. In 1957 he was augmented 

CAPTs Barchet and Lukas 

into the Regular Navy, and in 1959 
— following instruction at the School 
of Aviation Medicine, Pensacola — 
he was designated a naval flight 

Dr. Lukas served for a year as 
medical officer at Naval Postgradu- 
ate School, Monterey, Calif, then 
was ordered to the USS Lexington. 
As medical officer, he participated 
in her last cruise as an attack carrier 
in the Western Pacific. Subsequent- 
ly he served as assistant chief of the 
Ob/Gyn Service at Naval Hospital 
Oakland; as medical officer at Naval 
Air Stations Alameda, Calif, and 
Agana, Guam; and as base surgeon 
at Marine Corps Base Quantico, Va. 


U.S. Navy Medicine 

In 1971, he was ordered to Kenitra, 
Morocco, serving for two years as 
officer in charge of the station hos- 
pital and as aerospace medical con- 
sultant to the Royal Moroccan Air 
Force. In 1973 he became director of 
clinical services at Naval Hospital 
Corpus Christi. 

Dr. Lukas is certified by the 
American Board of Obstetrics and 
Gynecology. He is a fellow of the 
American College of Obstetricians 
and Gynecologists and of the Ameri- 
can College of Surgeons, and is a 
member of the Nueces County Med- 
ical Society, the American Medical 
Society, and the Aerospace Medical 
Association. He holds the American 
Campaign Medal, World War II 
Victory Medal, American Service 
Medal with star. Navy Unit Citation 
Medal, and Republic of Vietnam 
Meritorious Unit Citation Medal. 

CAPTs Museles and Senior 

RADM-selectee Melvin Museles 

(MC), commanding officer of Naval 
Regional Medical Center Jackson- 
ville since 1976, was born 24 Oct 
1929 in Boston, Mass. He graduated 
from Boston University in 1950 with 
a B.A. degree in chemistry, cum 
laude, and received his M.D. de- 
gree from Tufts University Medical 
School in 1954. 

Dr. Museles began his military 
service in 1954 as an intern at Naval 
Hospital Boston, with the rank of 
lieutenant (junior grade). He re- 
ceived his residency training in 
pediatrics at the same institution 
and at Children's Hospital Medical 
Center, Boston. 

Following a tour of duty at Naval 
Hospital Guantanamo Bay, Cuba, 
Dr. Museles entered civilian prac- 
tice but returned to active duty after 
only nine months. From 1959 to 
1962. he served as assistant chief of 
pediatrics at Naval Hospital Boston. 
Following tours as chairman of the 
Department of Pediatrics at Naval 
Hospital Portsmouth, Va. (1962- 
1967), and at Naval Hospital Be- 
thesda (1967-1971), he was ap- 
pointed assistant head of the Train- 
ing Branch, Bureau of Medicine and 
Surgery, in 1971; then head of the 
Training Branch in 1972. 

In July 1973, Dr. Museles was 
selected by the Secretary of Defense 
to serve as first executive secretary 
to the Board of Regents of the Uni- 
formed Services University of the 
Health Sciences, and in 1974 he was 
appointed the first associate dean of 
the USUHS School of Medicine. In 
these capacities he played a leading 
role in initial development of the 
university and its relationships with 
military teaching hospitals. 

Dr. Museles is certified by the 
American Board of Pediatrics and 
holds appointments as clinical pro- 
fessor of pediatrics at Georgetown 
University Medical School and as 
associate clinical professor of pedi- 
atrics at Howard University Medical 
School. He is a fellow of the Ameri- 
can College of Physicians and the 
American Academy of Pediatrics, 
and was pediatrician to the White 
House during the Johnson Adminis- 
tration. He holds many other aca- 
demic and administrative appoint- 
ments, as well as memberships in 
national professional organizations. 
His military awards include the Le- 
gion of Merit, the Meritorious Ser- 
vice Medal, the Navy Commenda- 
tion Medal, and the National De- 
fense Medal with Bronze Star. 

Naval Reserve RADM-selectee 
John R. Senior (MC) is commanding 
officer of Second Marine Division 
Medical Headquarters Detachment 
104, West Trenton, N.J. He is direc- 
tor of the Special Treatment Unit for 
Alcohol-Related Disorders and di- 
rector of the Office of Evaluation, 

Graduate Hospital, University of 
Pennsylvania. He also is associate 
professor of medicine at the univer- 
sity's School of Medicine. 

Dr. Senior was born 17 July 1927 
in Germantown, Pa. He entered the 
Naval Reserve in 1945 and served as 
a seaman, first class, with the Naval 
Air Transport Service, Pacific. He 
received a B.S. degree in physics 
from Pennsylvania State University 
in 1950, was commissioned an en- 
sign (HP) in 1951, and received his 
M.D. degree from the University of 
Pennsylvania in 1954. Following in- 
ternship and residency training in 
medicine at the Hospital of the Uni- 
versity of Pennsylvania, he spent 
three years as a research fellow in 
medicine at Massachusetts General 
Hospital and Harvard University. 

From 1962 to 1971, he was direc- 
tor of the Gastrointestinal Research 
Laboratories at Philadelphia Gen- 
eral Hospital, and from 1964 to 1970 
he served as director of the training 
program in gastroenterology for the 
National Institute of Arthritis and 
Metabolic Diseases, NIH. He was 
project director of the Computer- 
Based Examination Project for 
Measurement of Competency in 
Medicine of the American Board of 
Internal Medicine (1970-1974), di- 
rector of clinical investigation at 
Presbyterian-University of Pennsyl- 
vania Medical Center (1971-1973), 
and director of the Clinical Research 
Center, Graduate Hospital, Univer- 
sity of Pennsylvania (1973-1974). 

Since 1955, Dr. Senior has partici- 
pated in the Ready Reserve, serv- 
ing, among other assignments, as 
commanding officer, Philadelphia 
Medical Reserve Company Unit 4-3, 
and senior medical officer. Subma- 
rine Divisions, Naval Base Philadel- 
phia. He was designated a subma- 
rine medical officer in 1971, and a 
saturation diving medical officer in 
1977. He has been the Navy's medi- 
cal school liaison officer at the Uni- 
versity of Pennsylvania since 1966. 

Dr. Senior is certified and recer- 
tified by the American Board of In- 
ternal Medicine and is certified by 
its Subspecialty Board on Gastroen- 
terology. He is a consultant-lecturer 

Volume 69, May 1978 

on gastroenterology for the Veter- 
ans Administration, and a consult- 
ant to the National Board of Medical 
Examiners and the American Board 
of Internal Medicine. 

He is a fellow of the American 
College of Physicians and a member 
of the American Federation for Clin- 
ical Research, the American Gastro- 
enterological Association, the 
American Association for the Study 
of Liver Diseases {past president, 
1973-1974), the American Physio- 
logical Society, the American Soci- 
ety for Clinical Investigation, and 
the International Association for 
Study of the Liver. He holds the 
World War II Victory Medal, the 
Naval Reserve Medal, and the 
Armed Forces Medal. 

Naval Reserve R ADM -selectee 
Park W. Willis HI (MC) is medical 
officer for NRPERSMOBTEAM 
1713, Naval Reserve Center, South- 
field, Mich., and professor of inter- 
nal medicine in the Division of Car- 
diology at the University of Michi- 
gan Medical School. 

Dr. Willis was born 18 Nov 1925 
in Seattle, Wash. He entered the 
Navy under the V-12 program in 
1943. In 1948 he received his M.D. 
degree from the University of Penn- 
sylvania and was commissioned a 
lieutenant (junior grade) in the 
Naval Reserve. After completing a 
two-year rotating internship at 
Pennsylvania Hospital, Philadel- 
phia, he was assigned as staff medi- 
cal officer in internal medicine and 
cardiology at Naval Hospital Be- 
thesda, Md., following which he 
was assigned as battalion and then 
regimental surgeon to the First 
Marine Division in Korea. In Janu- 
ary 1952, he was ordered to Naval 
Hospital Bremerton, Wash., as staff 
medical officer in internal medicine 
and dermatology, and in September 
of that year he entered the resi- 
dency training program in internal 
medicine at University Hospital, 
Ann Arbor, Mich. 

Dr. Willis has participated in the 
Ready Reserve since 1952, and has 
remained at the University of Michi- 
gan since his residency, becoming 

junior clinical instructor in internal 
medicine in 1953; instructor in in- 
ternal medicine im 1954; assistant 
professor of internal medicine in 
1956; associate professor in 1959; 
and full professor in 1965. He has 
been the Navy medical school 
liaison officer at the university since 

Other responsibilities include ap- 
pointments as a consultant in cardi- 
ology to the Navy Surgeon General; 
as a consultant -lecturer at Naval 
Hospital Bethesda; as a consultant 
in internal medicine to the Veterans 
Administration Hospital, Ann 
Arbor; and as consultant to the 
Wayne County General Hospital, 
Eloise, Mich. 

Dr. Willis is certified by the 
American Board of Internal Medi- 

Medical Consultants to the Armed 
Forces. He is vice president of the 
Association of University Cardiolo- 
gists and past president of the 
Michigan Heart Association and the 
Detroit Heart Club. 

Dr. Willis holds the Presidential 
Unit Citation with star, the Naval 
Reserve Medal, the American Cam- 
paign Medal, the World War II Vic- 
tory Medal, the National Defense 
Service Medal, the Korean Service 
Medal with four stars, the Armed 
Forces Reserve Medal, the United 
Nations Service Medal, and the 
Republic of Korea Presidential Unit 

RADM-selectee John B. Holmes 

(DC), commanding officer of Naval 
Regional Dental Center San Fran- 

CAPTs Willis, Holmes, and Anderson 

cine and its Subspecialty Board on 
Cardiovascular Disease. He is a fel- 
low of the American College of Phy- 
sicians and the American College of 
Cardiology, and is a member of the 
American Heart Association, a 
member of the AHA Council on 
Thrombosis, and a fellow of the 
AHA councils on Clinical Cardiol- 
ogy, Arteriosclerosis, and Epidemi- 
ology. Other memberships include 
the American Federation for Clini- 
cal Research, the American Asso- 
ciation for the Advancement of 
Science, the International Society of 
Cardiology and its councils on Epi- 
demiology and Atherosclerosis, the 
International Society on Thrombosis 
and Haemostasis, and the Society of 

cisco, was born 20 Mar 1929 in 
Invermere, British Columbia. He 
received a B.S. degree in zoology 
from the University of Idaho in 
1950, and in 1954 was awarded his 
D.D.S. degree by the University of 
Washington School of Dentistry. 
That same year, he began active 
duty at Naval Training Center San 
Diego as a lieutenant (junior grade). 
Following duty at the Naval Post- 
graduate School in Monterey, 
Calif., Dr. Holmes was assigned as 
dental officer to the USS Badoeng 
Strait (CVE-116). He next served at 
Naval Station Treasure Island, San 
Francisco, then attended the Gen- 
eral Postgraduate Course, Naval 
Dental School Bethesda, after which 

U.S. Navy Medicine 

he was assigned to the Second 
Marine Division, Fleet Marine 
Force, Atlantic. 

Dr. Holmes completed residency 
training in prosthodontics at Naval 
Dental School Bethesda in 1963 and 
subsequently served as dental offi- 
cer aboard the USS Saratoga (CVA- 
60). Following a tour of staff duty at 
the Naval Dental School, he re- 
ported to BUMED for duty as head, 
Appointment and Assignment Sec- 
tion, Dental Division. In 1974, he re- 
ceived his M.S. degree in education 
from The George Washington Uni- 
versity and that same year became 
head of the Dental Division's Per- 
sonnel Branch, going from that post 
to his current assignment. 

Dr. Holmes is a diplomate of the 
American Board of Prosthodontics, 
an active fellow of the Academy of 
Denture Prosthetics, a charter fel- 
low of the American College of 
Prosthodontics, a fellow of the 
American College of Dentists, and a 
fellow of the International College 
of Dentists. He holds the Navy 
Commendation Medal and the Na- 
tional Defense Service Medal with 
Bronze Star. 

Naval Reserve RADM-selectee 
Frank H. Anderson (DC) is wing 
dental officer with the Fourth Ma- 
rine Aircraft Wing, New Orleans, 
and has a private dental practice in 
Johnson City, Tenn. 

Dr. Anderson was born on 27 Nov 
1929 in Johnson City, Tenn. He re- 
ceived his B.S. degree from East 
Tennessee State University in 1950 
and his D.D.S. degree from the Uni- 
versity of Tennessee College of 
Dentistry in 1953. That same year 
he was commissioned a lieutenant 
(junior grade) and served on active 
duty until 1956, with tours at 
Great Lakes, 111., and with the U.S. 
Naval Retraining Command in San 
Diego. Since then, as a member of 
the Ready Reserve, he has been 
affiliated with the Naval Reserve 
Center, Kingsport, Tenn.; the Naval 
Reserve Facility, Greenville, Tenn.; 
and the U.S. Navy Recruiting 
District, Nashville, Tenn. He has 
served as chairman of the Recruit- 

ing District Assistance Council, 
Nashville District for Recruiting, 
and has been Tennessee coordinator 
of the U.S. Naval Academy Blue 
and Gold Program since 1970. 

Dr. Anderson is a fellow of the 
Academy of General Dentistry and 
has been nominated for fellowship 
in the International College of 
Dentists. He is a member of the 
American Prosthodontic Society and 
the Southeastern Academy of Pros- 
thodontics, a past president of the 
First District Dental Society, and an 

alternate trustee to the Tennessee 
Dental Association. In 1976 he re- 
ceived the Tennessee Dental Asso- 
ciation's Fellowship Award for pro- 
fessional service to dentistry. 

Dr. Anderson is chairman of the 
Advisory Committee to the School 
of Dental Hygiene, East Tennessee 
State University, and co-chairman 
of the alumni fund drive for a new 
dental school building at the Uni- 
versity of Tennessee. He holds the 
National Defense Service Ribbon 
and the Naval Reserve Medal. 

New MSC Chief 

CAPT Paul D. Nelson (MSC) has 
been named seventh chief of the 
Navy Medical Service Corps. He 
will succeed CAPT William J. 
Green, Jr. (MSC), who will retire on 
1 Jun 1978. 

For the past year, CAPT Nelson 
has been director of manpower and 
facilities management at the Naval 
Medical Research and Development 
Command, Bethesda, Md. For three 
years prior to that, he was head of 
the Human Performance Division at 
the same command. 

Born 20 Sep 1932 in Akron, Ohio, 
CAPT Nelson was commissioned an 
ensign in the Medical Service Corps 
in 1956. He subsequently served as 
a research psychologist at the Naval 
School of Aviation Medicine, Pensa- 
cola; as a staff psychologist with the 
Naval Air Advanced Training Staff, 
Corpus Christi; and as a research 
psychologist with the Navy Medical 
Neuropsychiatric Research Unit, 
San Diego. In 1966 he was ap- 
pointed head of the Human Effec- 
tiveness Branch, Research Division, 
at BUMED, where he served until 
being transferred to the Naval 
Medical Research and Development 
Command in 1974. 

CAPT Nelson graduated from 
Princeton University in 1954. He 
received a master's degree in 
psychology from the University of 
Chicago in 1955, and in 1961 was 
awarded his doctorate in psychology 

CAPT Nelson 

from the same 
university. He 
holds a faculty ap- 
pointment as as- 
sociate professor 
(lecturer) in man- 
agement science 
at The George 
Washington Uni- 
versity, Washing- 
ton, D.C., and is 
a member of the 
editorial staff of 
the Journal of 
Armed Forces 
and Society. 

CAPT Nelson has been a member 
of the Navy Standing Committee on 
Personnel Training and Readiness, 
the DDR&E Behavioral Science 
Subcommittee, and the DDR&E 
Committee for Coordination of Re- 
search on Alcoholism and Drug 
Abuse. He also serves as executive 
chairman and U.S. national leader 
of the Technical Cooperation Pro- 
gram Action Group on Human Per- 
formance Research and Military 

He is a fellow of the American 
Psychological Association and pres- 
ident of that association's Division 
of Military Psychology. He is also a 
fellow of the Inter-University Semi- 
nar on Armed Forces and Society 
and holds memberships in Sigma XI 
and the International Association of 
Applied Psychology. 

Volume 69, May 1978 

Life Support Stretcher 

The Navy has long had need of a 
life support stretcher that would 
permit uninterrupted care and mon- 
itoring of critically ill patients in 
transit. Now the prototype of such a 
stretcher — incorporating a number 
of life-support features — has been 
developed at the Naval Ocean Sys- 
tems Center (NOSC), San Diego, 
under the sponsorship of the Naval 
Medical Research and Development 

The stretcher — known as the 
"portable life support stretcher 
unit" (PLSSU) — functions as a self- 
powered, self-contained crash cart 
during patient transportation. It can 
supply two to four hours of oxygen; 
provide ECG monitoring for up to 
five hours; deliver up to 50 defibril- 
lation shocks; and carry other sup- 
plies and equipment needed for 
suction, resuscitation, and treat- 
ment of shock. 

When configured for transfer of a 
patient from the primary care site to 
a hospital, the PLSSU consists of 
a standard canvas litter or Stokes 
litter attached to an equipment car- 
rier that is similar in dimensions 
and weight to a standard canvas 
litter with a patient on it. Thus the 
carrier — which has handles at both 
ends — can be handled separately 
and installed like a standard Utter 
in any military evacuation vehicle, 
with no modification of litter-rack 
spacing or equipment. 

When configured for transporting 
a patient within the hospital, the 
PLSSU consists of the equipment 
carrier and a hospital unit — a bed- 
like device attached to the carrier by 
quick-release pins. The height of 
the hospital unit, when attached to 
the carrier, is 30 inches — approxi- 
mately bed height — making for easy 
transfer of the patient to and from 
the stretcher. The unit's transpar- 
ent, uniform-density top and its full- 
length shelf for X-ray cassettes al- 
low patients to be X-rayed without 

being removed from the PLSSU. 

The prototype PLSSU has been 
undergoing testing and evaluation 
at NRMC San Diego, where it has 
been used for transfer of critically 
ill patients both within the hospital 
and in Medevac operations involv- 
ing Navy physicians, Navy corps- 
men, and Coast Guard helicopters. 
Trials of the PLSSU at sea have 
simulated the arrival of casualties 
by helicopter and landing craft, and 
their transfer from the flight deck 
and well decks to medical facilities, 

using standard patient-hoist ar- 
rangements, pallet-loading vehi- 
cles, and Medevac elevators. The 
PLSSU has demonstrated its capac- 
ity to quickly transform utility heli- 
copters into equipped Medevac 
units. It has also been shown to be 
fully compatible with civilian and 
military ambulances, and can quick- 
ly convert the latter into a trauma- 
type van. 

Future plans for the PLSSU pro- 
ject include development of a pre- 
production model, incorporating 
changes suggested by testing and 

— Story and photos submitted by W.T. 
Rasmussen. Ph.D., Head. Biomedical Engi- 
neering Branch, Naval Ocean Systems Cen- 
ter. San Diego, Calif. 92152. 


Equipment on carrier includes ECG monitor and defibrillator. 

NOSC personnel check out PLSSU in an HH-3A helicopter. 


U.S. Navy Medicine 

Notes & Announcements 

CAPT N.J. DeWitt 


CAPT Nellie J. DeWitt, NC, USN (Ret.), a former 
director of the Navy Nurse Corps, died 22 March 1978 
at Carl Vinson Hall in McLean, Va., at age 82. 

Born in Susquehanna, Pa., on 
16 July 1895, CAPT DeWitt re- 
ceived her nurse's training from 
the Stamford Hospital Training 
School, Stamford, Conn., before 
entering the Navy Nurse Corps 
during World War I. Her first 
duty station was at Charleston, 
S.C, During this time she also 
had duty aboard the USS Martha 
Washington, a transport ship en- 
gaged in carrying dependents 
and military personnel. She was 
placed on inactive duty in Octo- 
ber 1920, but returned to active 
duty in October 1922, and subse- 
quently served at many naval medical facilities in the 
U.S. and overseas. 

CAPT DeWitt was promoted to Chief Nurse in April 
1937 and served at U.S. naval hospitals in Guantanamo 
Bay, Cuba; Norfolk, Va.; Corona and Mare Island, 
Calif.; and at the Hospital Corps School, San Diego, 
Calif. In September 1944, she went to the Hawaiian 
Islands to be in charge of nursing activities at the U.S. 
Naval Hospital, Aiea Heights, with special duties as 
senior nurse on the Islands. In November 1945, she 
came to BUMED to assume duty as superintendent of 
the Navy Nurse Corps, and she was promoted to Cap- 
tain on 1 April 1946. 

An Act of Congress of 16 April 1947 made the Nurse 
Corps a staff corps of the U.S. Navy and gave its mem- 
bers permanent commissioned officer status, with com- 
mensurate pay and allowances. In accordance with this 
legislation, CAPT DeWitt's title was changed from 
superintendent to director. She held this position until 
her retirement on 1 May 1950. 

CAPT DeWitt held the World War I Victory Medal, 
American Defense Service Medal, Asiatic- Pacific Cam- 
paign Medal, American Campaign Medal, and World 
War II Victory Medal. 

LCDR Stuart W. McEwen ffl, MC, USN, a student of 
Navy Flight Surgeon Class 78-1, died 2 March 1978 in 
an aircraft accident during training at Naval Air Station 
Pensacola, Fla. 

The 34-year-old physician received his Bachelor of 
Science degree from Auburn University in 1966 and 
was awarded his doctorate in medicine from the Univer- 
sity of Alabama in 1970. He completed his internship at 
Charlotte Memorial Hospital, Charlotte, N.C. After 

finishing his residency in dermatology at the University 
of Alabama, he entered the Navy in 1975. 

Dr. McEwen served two and a half years as a staff 
dermatologist at NRMC Jacksonville before reporting 
to the Naval Aerospace Medical Institute (NAMI) for 
training as a flight surgeon last September. 

He was a member of Alpha Omega Alpha and a 
Diplomate of the National Board of Medical Examiners 
and the American Board of Dermatologists. He was 
posthumously designated a Naval Flight Surgeon. 


The University of Maine at Orono, Bangor, Maine 
will hold the following courses: 

• 15th Annual Industrial Hearing Conservation Insti- 
tute, 17-19 July 1978: concerned with responsibilities of 
industrial nurses and those actively interested in hear- 
ing-testing performance and related matters in hearing 
conservation. Participants are eligible for certification 
by the Council for Accreditation in Occupational Hear- 
ing Conservation and the award of 2.0 continuing edu- 
cation units by the Maine State Nurses Association. 
Tuition is $235. Room and board is $25 per day. 

• 26th Annual Institute in Occupational Hearing Loss, 
17-21 July 1978; designed for industrial physicians, 
safety engineers, otolaryngologists, audiologists, 
health management executives, and administrative 
personnel. Covers total field of hearing conservation 
programs, medicolegal and compensation aspects, 
and OSHA developments. Awards 27 credits in PRA 
Category 1 of AM A for physicians. Tuition is $275. 
Room and board is $25 per day. 

For descriptive brochures and applications write to: 
UMO Coordinator, 1721 Pine St., Philadelphia, Pa. 
19103, or phone (215) 735-0205. 


At the present time there is no mechanism to ensure 
uniform diagnostic coding of entries not covered in 
ICDA-8 (Eighth Revision, International Classification of 
Diseases, Adapted for Use in the United States) or 
BUMEDINST 6300.3 (Inpatient Data System). Person- 
nel are encouraged to use the services of Mrs. Muriel 
Brandford, RRA, the Medical Records Administrator at 
Naval Medical Data Services Center (NMDSC), in the 
solution of coding problems. Before coming to NMDSC, 
Mrs. Brandford was director of medical records, Down- 
state Medical Center, State University Hospital, New 
York, and a lecturer in the medical record administra- 
tion program at Downstate Medical Center. Address all 
inquiries to Commanding Officer (Code 40B), Naval 
Medical Data Services Center, Bethesda, Md. 20014, or 
call Mrs. Brandford on Autovon 295-0139. 

Volume 69, May 1978 

Anderson, MC, USNR ( Gastroenterol - 


(Subspecialties are indicated in parentheses) 

American Board of Anesthesiology 
CDR Lewis Mantel, MC, USN 

American Board of Dermatology 
CDR Walter D. Henrichs, MC, USN 
CDR Laut Q. Nguyen, MC, USNR 
LCDR Noel T. Brown, MC, USNR 
LCDR Robert B. Carlin, MC, USNR 
LCDR Stephen R. Damm, MC, USN 

American Board of Family Practice 
LCDR James M, Kasick, MC, USNR 
LCDR Michael K. Murphy, MC, USN 
LCDR Charles D. Saul, MC, USNR 
LCDR W.R. Schmits, MC, USNR-R 
LT Michael J. Lapenta, MC, USN 

American Board of Internal Medicine 

CAPT Jean-Jacques Gunning, MC, USN 

CDR Kirk E. Hippensteel, MC, USNR 

CDR Norman G. Hoger, MC, USNR 

CDR Joseph A. Kaufman, MC, USN (Cardiovascular 

LCDR Daniel S. 


LCDR Peter H. Belott, MC, USNR 

LCDR Samuel W. Berg III, MC, USN 

LCDR David E. Bybee, MC, USNR (Endocrinology and 

LCDR William J. Ceretto, MC, USNR 

LCDR Donald C. Gerhardt, MC, USNR (Gastroenterol- 

LCDR Bruce K. Lloyd III, MC, USN 

LCDR Harry J. Long III, MC, USN (Medical Oncology) 

LCDR Leonard P. Neumann, Jr., MC, USNR 

LCDR Wallace A. Rolniak, MC, USNR 

LCDR George Savides, MC, USN 

LCDR Thomas A. Schultz, MC, USNR (Endocrinology 
and Metabolism) 

LT Stanley B. Benjamin, MC, USNR 

LT Timothy P. Blair, MC, USNR 

LT Fred C. Brown II, MC, USNR (Gastroenterology) 

LT Michael D. Mottet, MC, USNR 

LT Charles R. Rost, MC, USNR 

American Board of Obstetrics and Gynecology 
CAPT Joseph L. Yon, Jr., MC, USN (special compe- 
tence in Gynecologic Oncology) 
CDR Grady G. Barnwell, MC, USN 
LCDR Alan R. Alexander, MC, USN 
LCDR Stephen B. Ganderson, MC, USN 
LCDR Robert J. Hartman, MC, USN 
LCDR David R. Lecloux, MC, USNR 
LCDR William L. Lynn III, MC, USNR 
LCDR George A. Ritcher, MC, USNR 

American Board of Orthopaedic Surgery 
CDR Bjorn C.J. Eek, MC, USNR 
LCDR Albert E. Becker, Jr., MC, USN 
LCDR James H. Deweerd, Jr., MC, USNR 
LCDR William A. Herndon, MC, USNR 
LCDR James R. Lafleur, MC, USNR 
LCDR James J. McCoy, Jr., MC, USNR 
LCDR Joseph M. Ricciardi, MC, USNR 
LCDR James R. Schneider, MC, USNR 
LCDR Joseph E. Trader, MC, USNR 
LCDR John F. Znider, MC, USNR 

American Board of Otolaryngology 
LCDR Graham Gilmer III, MC, USN 
LCDR Drew G. Sawyer, MC, USNR 
LCDR Edward J. Silvoy, MC, USNR 
LCDR George C. Swanson, MC, USNR 

American Board of Pathology 
CAPT John A. Henderson III, MC, USN 
LCDR Michael A. Fitzsimmons, MC, USN 
LCDR James R. McCole, MC, USNR 
LCDR Arjang K. Miremadi, MC, USNR 
LT Robin S. Foerster, MC, USNR 

American Board of Pediatrics 

CDR Bedford W. Bonta, MC, USN (Neonatal-Perinatal 

CDR Thomas M. Connor, MC, USNR 
LCDR Kenneth C. Castor, Jr., MC, USN 
LCDR Edward G. Hayhurst, MC, USNR 
LCDR Gary A. Incaudo, MC, USNR 
LCDR John W. Kuhn, MC, USNR 
LCDR Lewis Otero, MC, USNR 
LCDR William J. Thomas, MC, USNR 
LCDR Richard D. Torkelson, MC, USNR 
LCDR Eric A. Wulfsberg, MC, USN 

American Board of Plastic Surgery 
CDR George E. Siegfried, MC, USN 

American Board of Preventive Medicine 
LCDR Edward P. Horvath, Jr., MC, USNR (Occupa- 
tional Medicine) 

American Board of Psychiatry and Neurology 
CAPT Stanley J. Kreider, MC, USN 

American Board of Radiology 

LT M.L. Safer, MC, USNR (Therapeutic Radiology) 

American Board of Surgery 
LCDR Danny V. Cantwell, MC, USNR 
LCDR Bruce D. Baird, MC, USNR 
LCDR Richard A. Mayo, MC, USN 
LCDR George D. Miller, MC, USN 
LCDR John J. Tepas HI, MC, USN 
LCDR Charles F. Yeagle III, MC, USNR 

U.S. Navy Medicine 


Instructions and Directives 

Medical Malpractice Claims 

Before Public Law 94-464 was enacted, the doctrine 
of legal immunity protected some health officials from 
suit; however, the outcome of judicial decisions in indi- 
vidual situations could not be predicted with any cer- 
tainty. The intent of Congress in passing the law was to 
insulate all Department of Defense, Coast Guard, and 
Central Intelligence Agency medical personnel from 
the expense of defending malpractice suits and paying 
judgments or settlements. 

PL 94-464 covers all Armed Forces, DOD, and CIA 
physicians, dentists, nurses, pharmacists, and para- 
medical or other supporting personnel — including med- 
ical and dental technicians, nursing assistants, and 
therapists — performing medical, dental, or related 
health-care functions (including clinical studies and in- 
vestigations), if the alleged malpractice occurred while 
they were acting in the scope of their duties or employ- 

The law applies only to those claims filed on or after 8 
Oct 1976. 

"Scope of employment" is considered to mean all 
officially assigned duties. This includes, among other 
things, health care performed by Navy personnel as- 
signed to a civilian hospital, and health care performed 
by civilians training with or otherwise assigned to the 
Navy. "Scope of employment" does not include em- 
ployment of Navy personnel at civilian health-care facil- 
ities during nonduty hours ("moonlighting"). 

PL 94-464 extends coverage within the U.S. and its 
possessions by making suit against the United States 
under the Federal Tort Claims Act the exclusive 
remedy for an injured party. In those situations where 
the act does not apply (e.g., where the actions giving 
rise to the claim occurred outside the United States), 
the law allows the Secretary of Defense to hold harm- 
less, or provide liability insurance for, health-care per- 
sonnel. DOD Directive 6000.6 of 24 Aug 1977 delegates 
this authority to the Secretary of the Navy for Navy 
health-care personnel. 

All Navy health-care personnel in the categories de- 
scribed above are held harmless for damages resulting 
from negligent or wrongful acts or omissions while act- 
ing within the scope of duties and assigned to duty in a 
foreign country, or detailed for service with other than a 
federal agency, or if the circumstances are such as are 
likely to preclude remedy against the United States 

under the Federal Tort Claims Act. 

Health-care personnel of the Department of the Navy 
who are sued for Navy-related activities shall immedi- 
ately deliver all process and pleadings served upon 
them (or an attested true copy) to the commander of the 
naval installation to which they were attached at the 
time of the incident giving rise to the suit. 

Upon receiving process and pleadings, the com- 
manding officer shall promptly furnish copies to the 
appropriate U.S. Attorney, to the Attorney General, 
and to the Secretary of the Navy (Judge Advocate Gen- 

Upon receipt of process or pleadings — or upon notice 
of any claim or potential claim — an investigation con- 
forming to Chapter XX, JAG Manual, shall be con- 
ducted promptly, and the commanding officer shall 
report in the endorsement whether or not the acts giv- 
ing rise to the claim were performed in the scope of offi- 
cial duties or employment. 

Upon learning that a claim or lawsuit has been filed, 
the commanding officer shall immediately notify the 
Judge Advocate General (Code 14C), by message or 
telephone. If no investigation has been conducted, one 
will be expedited. Certified copies of all claims, service 
of process, and pertinent papers shall be forwarded by 
ordinary mail to the Judge Advocate General and to the 
officer in charge of the nearest Naval Legal Service 

The Judge Advocate General may redelegate author- 
ity and assign tasks to appropriate naval commands to 
ensure that: (1) liaison is maintained with the Attorney 
General and the appropriate U.S. Attorney; (2) the 
Attorney General has adequate information on which to 
base the scope of employment determinations required 
by PL 94-464; (3) all cases are monitored to ensure that, 
whenever appropriate, they are transferred to the ap- 
propriate U.S. District Court and deemed a tort case 
against the United States; and (4) arrangements are 
made, through the Department of Justice, to defend 
actions brought against any Navy health-care personnel 
for acts performed in the scope of their duties or em- 
ployment. The procedures of the Military Claims Act 
(Title 10, U.S. Code, Section 27J3) shall be used to de- 
termine costs, settlements, or judgments against such 
individuals. [Note: Questions about this instruction 
may be directed to BUMED Code 003; Autovon 294- 
4388. Ed.]— SECNAVINST 6300.3 of 14 March 1978. 

Volume 69, May 1978 

Scholars' Scuttlebutt 

How to Get the Training You Want 

Application time is here. Scholarship students who 
will graduate in late 1978, or in May or June 1979, are 
beginning to make decisions about training that will 
determine to a great extent their professional future. 
The Navy must Figure prominently in these plans. 

Most of you will serve an operational or nonspecialty 
tour during your continuum of professional experience 
in the Navy. As presently projected, this operational 
tour will be scheduled at the end of your first year of 
graduate medical education when the interruption will 
least disrupt your training and when the experience will 
contribute substantially to your development as a Navy 

We have consolidated many First-year training posi- 
tions in the medical and surgical specialties into a basic 
medicine and basic surgical training year. These broad- 
based programs will provide the educational foundation 
for entry into specialty training. 

We know that you have many questions about your 
training. Navy Medical Department program managers 
have already discussed with many of you your con- 
cerns, reservations, and questions about your future. 
To help you further, we are publishing here general 
guidelines on the application process, portions of the 
application package which will be sent to you this 
month, and a list of directors of medical education at 
the Navy's training hospitals. 


1. The Navy is no longer seeking First-year trainees 
under the National Intern and Resident Matching Pro- 
gram of the American Medical Association <AMA). It 
is essential that you, as a participant in a Navy subsidy 
program, know this. 

2. In accordance with the provisions of the Armed 
Forces Health Professions Scholarship Program 
(AFHPSP), you are required to apply for your First year 


of graduate medical education in the Navy. The follow- 
ing schedule will apply: 

1 May 1978 — Scholarship students entering (or about 
to enter) their senior year will receive a list of First-year 
positions available in 1979. Application forms and in- 
structions will also be supplied. 

1 Sept 1978 — Closing date for receipt of applications 
in the Bureau of Medicine and Surgery. 

September 1978 (exact date to be announced) — 
Selection committee meets in Washington, D.C., to 
select First-year trainees for all hospitals. 

October 1978 (exact date to be announced) — Candi- 
dates advised of their selection or nonselection. 

15 Nov 1978 — NotiFication of selection or nonselec- 
tion for deferments mailed to students who have re- 
quested deferment of more than one year. 

3. We plan to offer 252 First-year positions in eight 
naval hospitals. Programs will include basic medicine, 
basic surgery, family practice, obstetrics/gynecology, 
pediatrics, and psychiatry. 

Programs in basic medicine and basic surgery will be 
broad-based. Programs in family practice, obstetrics/ 
gynecology, and pediatrics will consist of 12 months in 
a single discipline. First-year training in psychiatry will 
consist of no more than three months of psychiatry, four 
months of internal medicine, and other electives. 

All students who wish to continue beyond the First 
year of graduate medical education will be required to 
reapply for training. 

4. AFHPSP students must list all naval hospitals, in 
order of preference, that offer the training program 
they desire. Candidates may also list alternate program 
preferences, with hospital preferences for these alter- 
nate choices. AFHPSP students who do not list all naval 
hospitals that offer their desired program will be as- 
signed preferences for the unlisted hospitals. Addi- 
tional specialty preferences will not be assigned, how- 

It is important that candidates for all basic medicine 

U.S. Navy Medicine 


CDFI R.W. Higgins, MC, USN 

CAPT D.R. Cordray, MC, USN 

At the Bureau of Medicine and Surgery: 

Naval Regional Medical Center 

Naval Regional Medical Center 

CAPT S.J. Kreider, MC, USN 

Charleston, S.C. 29403 

Portsmouth, Va. 23708 

BUMED Code 0011 
Washington, D.C. 20372 

CDR S.A. Bore), MC, USN 

CDR Walter V.R. Vieweg, MC, 

Phone: (202) 254-4279 

Naval Regional Medical Center 


Camp Pendleton, Calif. 92055 

Naval Regional Medical Center 

CDR C.B. Mohler, MSC, USN (Ret.) 

San Diego, Calif. 92134 

BUMED Code 314 

CAPTC.L. Gaudry, Jr., MC, USN 

Phone: (202) 254-4339 

Naval Regional Medical Center 

CDR DM. Robinson, MC, USN 

Jacksonville, Fla. 32214 

Naval Regional Medical Center 

At the Naval Health Sciences Education 

Oakland, Calif. 94627 

and Training Command: 

CDR E.L. Taylor, MC, USNR 

CDR C.T. Cloutier, MC, USN 

Naval Aerospace and Regional 

CDR C.R. Mock, MC, USN 

HSETC Code 4 

Medical Center 

National Naval Medical Center 

Bethesda, Md. 20014 

Pensacola, Fla. 32512 

Bethesda, Md. 20014 

Phone: (202) 296-0648 


HVTOS riWf'IS (G-G9) [formmrl, MVtttt 1*9) 




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This package contains important 
information concerning pathways 
that are available to you for grad- 
uate medical education. Read it 
carefully and submit your applica- 
tion in accordance with the instruc- 
tions provided. 

If you will be graduating prior to 
May or June 1979, and you are 
selected for training in the Navy, 
your training will commence upon 
graduation providing the director of 
the program for which selected has 
a vacancy in his training quota at 
that time. If there is no such vacan- 
cy, your training will commence on 
1 July 1979. The scholarship stipend 
will be discontinued for students in 
the Armed Forces Health Profes- 
sions Scholarship Program on the 
date of completion of requirements 
for their degree if more than 45 days 
will elapse prior to receipt of the 
degree. Candidates who receive 
their degree early but cannot com- 
mence training prior to 1 July 1979 
will be considered on an individual 
basis for temporary active service at 
their hospitals to await the com- 
mencement of training. 

College Rank in Class Form 

Volume 69, May 1978 


a Prl<iej *«t itsta-rent 

Tbi Chief, Burtmi Ef Medicine a^tf Surgery [«TTN: Cone 1J4), Navy Sep ai" tmen <.., UlMlilrtgU'ri, D.C. 20577 

5-jfej; firaauetr Medical Eaucallon and appo I r tw I In lit Navy Medical Carps} aoplicttlcn <af 

(fur list only tif ttudmts Tn (hair list jt*f of atdieal of a simp attic Eehoel h 
Eiwl: (]| PhjilciJ eamfltian ililaral 

1. Il Is reiauMted Ui*t lhi± letter be considered •■ a T application Tor Vn ti-jinliSJ proarwisl Uiat 
are listen telBH in in* «■«* of "y pj-eferef*re wid. If I "old m mtBirlwiit in a Navy itvdant priin 
il if reojuntrd ttut It ilH t» coniiMJ-d M my *pel I dtion for *■ appointment In in* Mmy Kedleal Certs. 




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Ba&ic Mcdlcln* or Basic Surgery is lijlfd at, a prafercrua,, indlcqlr In eBlu«*l PSSEed 
"fPECULTt INTITEST Th* thai ydu plan la wsnUiallv enter. Such It tttUfaMl 
af preferemio .Ill not be tilnHFng bjl »llj r*r)ast only your Interest It Ihln lima, Ur 

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PC taw preference 1% 
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2. Enclosure (1 I 

3. Under i<eEaf al 

Tfle ttil«nL of >r ahn/aleal csndlLtee 

caiar i =.h±ll have the dew or «jr [crcol sronloi 
entailer- I understand that adoT Uiinal iCUers i 
*nd Surgery at th* addrep* p*fviB|ji4/ noind in 1 

iroed for liielvalori Irt ety file, 

n i^j-U-eaM lranisrip-1 of Oy oraoe-s and 
reraraxridalian sail be fonrarneif la the 

In the Ivan.! r, training position, li «t Ariliiblt for -t In i na^al hatpilal. It is requested n>al I 
mtsd a derermant of my active ierviua nblicalloft u nl 1 1 [ shall have LoiplfeUif Ifainliiu in a Blvillan 
^tilullun aa nuled baleo lappliceBlo only la aLjdanU In -.he i.rmod Forr.-s Heal Ih Profess [ami Schol^rshl 
iqra and '.■■..„■ U»), 

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TD m «i*Uf 1E9 0"^ 

5. I Laideraland that If ] » not selecttd fur li-jlmlng In i 
defermant to enmpljila ful] Ij-s^nirj in a civilian I 
dclayd! Icr era year only !u parllcipata In ona ytir of gratd 
inatltuilcfl. at lha and Bf that pariad 1 «J11 bit callsd t« > 
lo fctutfifitl *l» hold kpBBlnUentE lr Nsvy student frunrimsj. 

eouaalitih In * alvUian 
;«. UppilCBblc anly 

If you Mill ecnglel 

EK*Ct date of 1 

please Indittat* ine Eenalfiion date in till Ecac*: 



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UrtoWr the authsrlty of 10 UoC, S US[ Ul and ExeculUe arspr WS7, infoneatiw 
■■eojMiinn here jp vi]| fcr i,Hj to avduain jwur apeliCatlar '&# ej-ukiate wtfiBal 

'edetatSB*!, Diadokur* of Ihe InforFiilInn j B vnl^nl.M-j, hjl failure iopa-ovide 
the information *ay rtault Id delay and BCaalhle Diiaor-rcval of the apelicatTpn. 

























































Special Notes: (A) 1st yr. programs in Fam Prac, 0B/GYN t and Feds will be 12 months In a single 

(B) Programs in Psych will offer a broad-based clinical year to include 4 months in 
Int Med, not sore than 3 months In Psych, plus electives, 

(C) The Basic Med and Basic Surg training year will contain a minlTTiun of 4 months of 
Int Med, A months of Surg, plus electives. These programs are structured in order 
to provide the trainee with the background required to enter training In specific 
specialties at later dates- Current plans are that trainees in 3asic Med will be 
prepared to enter residency programs in Anes, Derm, Int Med ? Ncuro, Ophtli and Redlo. 
Basic Surg Trainees will be prepared to enter residency programs in all surgical 
specialties including Oto, Ottho, Urol, Gen Surg and Seuro Surg. Ample opportunity 
will exist for crossovers into other specialties after completion of the first year 
of Graduate Medical Education in any of the programs listed in the breakdown at the 
top of this page* 

(I) Electives will be offered according to the trainees preference as approved by the 
program director. 


(E) All selections for first year GME are for one year only. All trainees who desire 

to continue training beyond that year must reapply upon reporting to their training 

and basic surgery programs state the discipline in 
which they are currently interested. Candidates may 
use the remarks section of the application to draw the 
selection committee's attention to any important per- 
sonal considerations. 

5. Selection for Navy programs: AFHPSP students 
who are selected for a training program in a naval hos- 
pital will be required to enter that program. Scholarship 
students who state inappropriate preferences for spe- 
cialties not listed as available (such as pediatric allergy, 
gastroenterology, and plastic surgery) will be con- 
sidered for training positions in the basic specialty — 
pediatrics, basic surgery, basic medicine, etc. 

6. Nonselection for Navy programs: Scholarship 
students not selected for training programs in a naval 
hospital will be so advised, and will be free to seek first- 
year graduate medical education positions in the civil- 
ian sector. 

7. Active-doty deferments: At the same time they 
apply for Navy training programs, AFHPSP students 
who desire a full residency in a civilian institution must 
request permission to delay serving their active-service 
obligation in order to participate in such training. The 
civilian institution need not be named, but the desired 
specialty and length of the delay must be clearly stated. 
Students not selected for Navy programs will be ad- 
vised in time to allow them to submit lists of preferred 
civilian institutions to the National Intern and Resident 
Matching Program (AMA) or the Intern Registration 
Program of the American Osteopathic Association 

Students who are not selected for Navy programs, or 
for active-duty delays to complete full training in a spe- 
cialty, will be assured a maximum of one year's delay in 
order to complete an internship or the first year of grad- 
uate medical education in a civilian institution. Prior to 
15 August of this "delayed" year, they may then apply 
for a deferment to complete a full residency. 

If applications for second-year positions or defer- 
ments cannot be approved, students will be called to 
active service as general medical officers at the end of 
their first year of training. In subsequent years they will 
be eligible to apply or reapply for residencies in naval 
hospitals. If not selected, they may apply or reapply for 
release from active duty in order to pursue a residency 
in a civilian institution. Upon completion of training, 
they must return to active service to fulfill their remain- 
ing obligation. 

AH requests for residencies and active-duty delays 
will be considered in light of the Navy's anticipated 
needs. Candidates are cautioned that requests to com- 
plete full specialty training, whether in a naval hospital 
or a civilian institution, may not be approved. The 
needs of the Navy must remain paramount. However, 
all candidates are assured of completing one year of 

graduate medical education in either a Navy or a 
civilian program. 

Students who will begin their first year of graduate 
medical education in 1978 have been advised by sepa- 
rate correspondence of the procedure through which 
they can apply for further training in the Navy or for 
active-duty delays to complete full specialty programs. 

It is essential that all scholarship students prepare 
themselves for the contingency that numerical limita- 
tions may preclude their selection for first-year pro- 
grams in naval hospitals. Candidates are urged to reg- 
ister with the National Intern and Resident Matching 
Program (AMA) or the Intern Registration Program 
(AOA). Of course, students who wish to seek training 
on their own, if not selected by the Navy, are free to do 
so. Students registered with an intern placement plan 
will withdraw from the plan if selected for a Navy pro- 

As in the past, the Navy will offer unfilled first-year 
positions to qualified students who do not obtain posi- 
tions under the AMA or AOA placement plans. Infor- 
mation concerning such vacancies will be available each 
year after the AMA and AOA placement announce- 
ments are made. 

8. Students are urged to visit the naval hospitals in 
which they are interested for interviews, the results of 
which are forwarded to BUMED to become part of the 
student's application file. Interviews must be com- 
pleted prior to 15 Aug 1978; results must be received in 
BUMED before 1 September. Candidates should not 
consider a program director's indication of acceptance 
as the final placement determination. It is not uncom- 
mon for two or more program directors to state a prefer- 
ence for the same candidate, and in such cases a deci- 
sion must be made through the internal Navy matching 
operation. The results of this matching may place a 
candidate in a hospital or a program that is lower on his 
or her preference list than anticipated. 

9. The provisions of these guidelines that pertain to 
active-duty delays, and the requirement to state multi- 
ple hospital preferences, do not apply to students in the 
Medical and Osteopathic Scholarship Program (MOSP). 
These students may continue to apply to as many Navy 
and civilian programs as they desire. However, they 
may participate in civilian training programs only dur- 
ing their first year of graduate medical education. Ap- 
plication procedures for training in naval hospitals are 
as stated in these guidelines, and the schedule of dates 

10. It is the responsibility of students to arrange for 
their medical or osteopathic school dean to complete 
the college-rank-in-class form and append to it a copy of 
the student's up-to-date transcript and a letter of rec- 
ommendation, to be forwarded to the Bureau of Medi- 
cine and Surgery. 

Volume 69, May 1978 




Seventy Years Old, but Young at Heart 

In this, our seventieth year, it is heartening to reflect on the vitality 
of the Navy Nurse Corps. As the saying goes, we're not get- 
ting older; we're getting better. 

The Navy nurse of today is quite different from his or her sister 
of 1908. The Nurse Corps officer of 1978 can be found filling a wide 
variety of positions, all of them vital to the mission of the Medi- 
cal Department. 

tn the area of clinical practice, Navy nurses are serving as nurse 
anesthetists, primary care practitioners, and clinical specialists, 
as well as in the more traditional clinical roles. 

In the educational field, there are Nurse Corps officers involved in 
continuing education, staff development, specialized skill train- 
ing, curriculum development, patient education, and the 
administration of education programs. 

In addition to nursing service administration, some Nurse Corps 
administrators have been assigned to executive medicine billets. 

In celebration of this anniversary, the Nurse Corps officers pictured 
here are some of those who have been nominated by their com- 
mands as representative of the hundreds of outstanding individuals 
whose dedication has made the Nurse Corps what it is today. 

To all of you, a very happy Birthday, and many, many more. 

Rear Admiral, NC, USN 
Director, Navy Nurse Corps 

LTJG Sandra Lee Block (USNR) was selected as one of 
the nurses to staff the new Intensive Care Unit at 
NRMC Jacksonville. An outstanding bedside nurse, 
she is skilled in administering specialized care to coro- 
nary and critically ill patients. On the unit, she teaches 
as she works, sharing her knowledge with nurses, 
corpsmen, and patients. 


U.S. Navy Medicine 

(Below) In addition to serving as a skilled member of the Critical Care Unit staff at 
NRMC Corpus Christi, LT Jose Bianco (NC) is a registered emergency medical 
technician instructor. He assists in presentation of the command-sponsored Emer- 
gency Medical Technician Course and has also conducted cardiopulmonary resus- 
citation classes. (Bottom) LT Rachel V. Allison (USNR) introduces new Marines to 
the benefits of Navy medicine. As senior nurse at the Naval Hospital Beaufort 
Branch Clinic, Marine Corps Recruit Depot, Parris Island, S.C., she has overall 
supervision of the psychiatric ward, emergency room, cool room, central supply, 
and recruit processing section. 

Volume 69. May 1978 



Assigned as primary care 
coordinator on the diabetes 
team at NRMC Oakland, 
LCDR Barbara Schupeltz 
(USNR) has earned much 
credit as a nurse educator. 
Since her work began, says 
her command, "we have 
seen an increased aware- 
ness, interest, and compli- 
ance in our patient popula- 
tion. This has resulted in 
fewer hospitalizations and, 
we believe, a better quality 
of life for the patient with 

Of CDR S. Ann Ross (above left), her commanding officer at NRMC 
Camp Lejeune says: "She belies George Bernard Shaw's dictum that 
'He who can, does; he who cannot, teaches,' by being a dedicated doer 
in addition to an eminent teacher. Her contributions to our delivery of 
intensive care are measured in lives, not words." (Right) LT Alexandra 
Geeza (USNR), clinical instructor at NRMC Great Lakes, brings in- 
genuity and creative talent to her work, often making her own clever 
visual aids for use in educational programs. 


U.S. Navy Medicine 

{Top left) CDR Julia O. Barnes, chief of 
nursing service at NH Lemoore, Calif., 
has made a notable contribution to her 
command's accomplishment of mission. 
Like most chief nurses, she can be 
found in the hospital early in the morn- 
ing and late at night, helping out and 
providing guidance where needed. (Top 
right) LT Richard A. Dunn (NC) has 
been responsible for a number of initia- 
tives that have benefited patients and 
staff at NRMC Hawai i . He served on the 
committee that established a regional 
Emergency Technician Course and is 
now one of the course instructors. He 
also initiated and then managed a 
weight control program for active duty 
personnel with an 85% success rate. 
(Left) LT John E. Robson, a designated 
SAR nurse attached to NH Whidbey 
Island, Oak Harbor, Wash., ensures 
continuity of nursing care to patients 
aboard MED-EVAC helicopters. An ac- 
tive member of the Emergency Nurses 
Association, LT Robson is dedicated to 
providing quality care in all areas of 
emergency medicine. 

Volume 69, May 1978 


NURSE CORPS (continued). 

Other Nominees 

The officers pictured on these pages are 
only some of the outstanding nurses who 
were nominated by their commands for 
special recognition in this issue. Space does 
not permit us to include all nominees, but 
we wish to recognize here those nominated 
officers whom we cannot picture. 

LTJG Steven E. Anderson, NC, USNR, NRMC 
San Diego, Calif.; LT John Boyer, NC, USN, 
USNH Roosevelt Roads, P.R.; LT Carolyn Z. 
Carlton, NC, USN, NRMC Orlando, Fla.; CDR 
Clarence Cote, NC, USN, NRMC Newport, R.I.; 
LCOR Elaine B. Hicks, NC, USN, NRMC Mem- 
phis, Tenn.; LT Joan Huber, NC, USN, NSMC 
New London, Groton, Conn.; LT Judith Lonv 
bardi, NC, USN, NRMC Charleston, S.C.; LCDR 
Barbara R. Matuszewski, NC, USN, NRMC Or- 
lando, Fla.; LTJG Kathleen A. McDonald, NC, 
USNR, NRMC San Diego, Calif.; LT Kristine E. 
Minnick, NC, USNR, U.S. NRMC Guam, M.I.; 
LTJG Gaither Pennington, NC, USNR, NRMC 
Portsmouth, Va; LTJG Diane F. Quackenbush, 
NC, USN, NRMC Oakland, Calif.; LCDR Karen 
A. Rieder, NC, USN, NRMC Oakland, Calif.; 
CDR Cynthia A. Schultz, NC, USN, U.S. NRMC 
Okinawa, Japan; LT Elinor J. Spita, NC, USN, 
NRMC Philadelphia, Pa.; LTJG Edward Uidrich 
III, NC, USNR, NRMC New Orleans, La.; LCDR 
Patricia Willhelm, NC, USN, USNH Guantanamo 
Bay, Cuba; ENS Eliot Winecour, NC, USNR, 
NRMC Portsmouth, Va.; LCDR Ann Yahner, NC, 
USN, NH Cherry Point, N.C.; LT Nancy Zabel, 
NC, USN, NRMC Long Beach, Calif. 

Recognized for her professional expertise as senior nurse 
anesthetist at NH Patuxent River, Md., LCDR Fay Wray also 
functions as inservice coordinator. She has compiled a booklet 
on inhalation therapy and has taught it to civilian and military 
staff. Practicing what she preaches about the value of 02 to 
healthy body tissue, CDR-selectee Wray keeps fit by jogging. 


U.S. Navy Medicine 

(Left) As educational coordinator at 
U.S. NRMC Yokosuka, Japan, LT Mi- 
chael Monahan (IMC)— shown here 
aboard the USS Constellation— has 
been instrumental in providing training 
and nursing care support to shipboard 
medical departments. As a result, ship- 
board visits, consultative services, and 
training programs for shipboard corps- 
men have become a regular part of fleet 
services at Yokosuka. (Bottom left) U.S. 
NRMC Subic Bay, R.P., nominated LT 
Nancy J. Owen for special recognition 
because of her "unique ability to inspire 
peers and subordinates to increase their 
knowledge and skill and function to the 
fullest extent of their potential. She 
readily accomplishes projects which 
others consider difficult or impossible." 
(Bottom right) LTJG Robert E. Butzow, 
NC, USNR, has made exceptional con- 
tributions to nursing service and the 
mission of NH Port Hueneme, Calif. 
His versatility and adaptability in crisis 
staffing situations have been outstand- 
ing, and he has continued to seek out 
new learning experiences, excelling in 
all his endeavors— particularly as a 
guide and teacher of corpsmen. 

Volume 69, May 1978 


Education & Trainin 


Opportunities for Nurse Corps Officers 

Nurse Corps education and train- 
ing is administered through the 
Naval Health Sciences Education 
and Training Command. The Nurse 
Corps Programs Directorate within 
HSETC is responsible for planning, 
coordinating, administering, and 
evaluating the various education 
and training programs to meet re- 
quirements set forth by the Bureau 
of Medicine and Surgery. 

Educational opportunities open to 
Nurse Corps officers include: 

Full-time duty under instruction. 
The assignment to full-time duty 
under instruction prepares Nurse 
Corps officers to function more ef- 
fectively and to assume positions of 
increased responsibility. It provides 
a program of continuing education 
for Navy nurses while they are on 
active duty and enhances retention. 

While they are attending school, 
ail Nurse Corps officers receive full 
pay and allowances of their rank, in 
addition to ail tuition costs. 

The service obligation for under- 
graduate and nondegree full-time 
instruction is two years for the first 
year of education and six months for 
each additional six months or part 
thereof. The service obligation for 
graduate education is three times 
the length of the education, for the 
first year or portion thereof, and six 
months for each additional six 
months or part thereof. (See BU- 
MEDINST 1520.14 series.) 
• Undergraduate, graduate, and 
doctoral programs: Full-time in- 
struction in civilian colleges and 
universities — in General Nursing, 
Nursing Service Administration, 
Nursing Education, Research, Clin- 
ical Specialties, and Nurse Practi- 
tioner programs — is offered to qual- 

ified Nurse Corps officers in the 
Regular Navy. 

• Naval Postgraduate School, Mon- 
terey: Offers a course in Navy Man- 
power/Personnel Management, 
leading to an M.S. degree, to quali- 
fied Nurse Corps officers in the 
Regular Navy. 

• Anesthesia program: A two-year, 
Navy-sponsored program estab- 
lished to meet the demands for, and 
replenish the supply of, registered 
nurse anesthetists. The program is 
accredited by the American Associ- 
ation of Nurse Anesthetists and con- 
sists of one academic year of study 
at George Washington University, 
Washington, D.C., and 15 months 
of clinical training at selected naval 
regional medical centers. The uni- 
versity offers an option for the stu- 
dent to elect to fulfill academic re- 
quirements leading to a B.S. degree 
in Nursing Anesthesia. The addi- 
tional requirements for the degree 
may be met before or after comple- 
tion of the nondegree program. 

The anesthesia program is avail- 
able to Nurse Corps officers of the 
Regular and Reserve Navy on active 
duty. One year of college-level sci- 
ence, to include a semester of chem- 
istry, is a prerequisite. 

• Nurse practitioner program: As 
a result of increasing demands for 
nurse practitioners, full-time duty 
under instruction is offered to pre- 
pare Nurse Corps officers to func- 
tion as primary care nurse practi- 
tioners in the areas of Family Prac- 
tice, Pediatrics and Ob/Gyn. 
Courses are offered to both Regular 
and Reserve officers in nondegree 
programs, and to nurses of the Reg- 
ular Navy in civilian Master's 
degree programs. 

Operating-room orientation. This 
course offers junior Nurse Corps of- 
ficers an opportunity to become 
acquainted with the range of techni- 
cal skills basic to effective patient 
care in the operating room. The 
nurse will then easily adapt previ- 
ously learned scientific principles to 
this specialty area. The course 
consists of six weeks of temporary 
additional duty (TAD) funded by 
HSETC, Upon completion, the 
Nurse Corps officer will return to 
the originating command for assign- 
ment in the operating room at the 
beginning staff nurse level. 

Short courses. Short courses, in- 
stitutes, seminars, and workshops 
conducted by other federal agen- 
cies, civilian universities, institu- 
tions, and professional organiza- 
tions, along with Navy-sponsored 
short courses offered at naval re- 
gional medical centers, constitute a 
means by which all Nurse Corps of- 
ficers may acquire continuing edu- 
cation. These courses are offered as 
a retention factor as well as a re- 
quirement for relicensure and indi- 
vidual development of expertise. 
(See BUMEDINST 4651.1 series.) 

Part-time outservice instruction. 
Tuition aid for part-time study in 
civilian universities in off-duty 
hours is offered to nurses working 
toward further nursing education 
and willing to obligate themselves 
for two years upon completion of the 
last course. (See BUMEDINST 
1500.7 series.) 

All inquiries regarding Nurse 
Corps education should be address- 
ed to: Commanding Officer, Health 
Sciences Education and Training 
Command (Code 7), NNMC, Be- 
thesda, Md. 20014. 


U.S. Navy Medicine 


Factors Contributing to Work-Related 
Accidents Aboard U.S. Navy Ships 

LT Mark C. Butler, MSC, USNR Allan P. Jones, Ph.D. 

LT James M. La Ftocco, MSC, USN 

The identification of factors influencing work- 
related accident or injury continues to be a problem 
of considerable concern to naval service personnel. 
Such accidents, especially aboard ship, often lead to 
serious decrements in work group performance and 
thus impair overall operational readiness. 

In a review of studies examining causes of indus- 
trial accidents, Surry (J) concluded that individual 
and environmental factors were important contribu- 
tors to accident morbidity, although few attempts 
have been made to integrate such factors into an 
overall framework. 

Recent work by Pugh, Erickson, and Jones (2\ rep- 
resents an initial step toward the development of a 
more comprehensive perspective. These authors in- 
vestigated the relative influences of work area condi- 
tions and individual characteristics upon perceptions 
of safety and actual trauma rates aboard Navy ships. 
At the division level, quality of equipment, worker 
experience, job standards, and the degree of 
congruity between individual abilities and specific 
job requirements were found to be more strongly 
related to safety judgments and actual trauma rates 
than were individual difference measures. In addi- 
tion, such relationships were strongest for division 
members who normally worked in hazardous sur- 
roundings and who also perceived their work en- 
vironment as extremely unsafe. 

Building on these findings, Gunderson {3) focused 
more specifically on accident and trauma differences 
among various shipboard divisions. He reported that 

From the Environmental and Social Medicine Division, Naval 
Health Research Center, San Diego, Calif. 92152, where LTs 
Butler and La Rocco are research psychologists and Dr. Jones is 
Head, Fleet Medicine Branch. 

Report Number 77-59, supported by the Naval Medical Re- 
search and Development Command, Department of the Navy, 
under Research Work Unit ZM51. 524.002-5021. 

the members of Engineering Divisions (i.e., boiler 
technicians and machinist mates) perceived their 
work area environments as extremely unsafe and 
experienced higher accident and injury rates than 
did members of all but one of the remaining ship 

The one exception occurred among members of 
Deck Maintenance Divisions, Personnel in these 
divisions perceived their work environment as only 
slightly below average in area safety, whereas their 
trauma rate was higher than that of divisions whose 
work areas were evaluated as the most hazardous on 
the ship. In fact, Deck Maintenance Divisions re- 
ported accident rates equal to or slightly higher than 
those reported by Engineering Divisions. 

Such findings raised several questions about the 
effects of situational hazards on work-related trau- 
ma. For example, personnel in the Engineering Divi- 
sions work in the boiler room and in other machinery- 
oriented spaces aboard ship. High trauma rates for 
these men might be explained rather simply by situ- 
ational factors such as equipment-related hazards. 
Deck personnel, on the other hand, while reporting 
the highest trauma rates, did not evaluate their work 
environments as unusually hazardous. Thus, it is 
necessary to explore whether other, nonequipment 
factors might be responsible for the trauma rates ex- 
perienced by these individuals. 


One possible explanation for the Deck Mainte- 
nance anomaly might be that individual characteris- 
tics are exerting a greater influence in Deck than in 
other divisions. 

Along this line, Kleinman (4) studied personnel 
factors associated with maintenance-related naval 
aviation accidents and found that older ( > 21 years), 

Volume 69, May 1978 


more experienced (> E-4), and better educated (> 12 
years) workers were less likely to be involved in 
injury-producing mishaps than were their younger, 
less experienced, and more poorly educated cowork- 

On the other hand, neither the Pugh nor the Gun- 
derson studies included a direct assessment of the 
potential role of such individual factors. While these 
measures were assessed indirectly, characteristics 
such as age, pay grade, and education were not in- 
cluded. Thus, as noted by these authors, their 
studies may not have provided a fair assessment of 
the role of such individual measures. 

Differences in personnel composition are not the 
only possible explanation, however. Recent devel- 
opments in social systems approaches to health and 
personnel effectiveness have suggested several al- 
ternatives [5,6,7). 

One such alternative, which has received consid- 
erable research attention in the past, is concerned 
with determining the influences of leader behavior 
(8). It seems reasonable to expect that for individuals 
working in either hazardous or potentially hazardous 
environments, leaders evaluated as uninvolved in 
task completion, untrustworthy or nonsupportive, 
and generally incapable of providing effective direc- 
tion may contribute indirectly to increased injury 
rates (7). 

Such reasoning suggested that it might be fruitful 
to explore more directly the degree to which per- 
ceived leadership style and personnel characteristics 
were related to accident and trauma rates in both 
Deck and Engineering Divisions. 

Information about demographic composition as 
well as perceived leader behavior was obtained from 
776 male enlisted personnel in the "B" (Boiler), 
"M" (Machinery), and Deck Divisions of 15 U.S. 
Navy combat ships. These ships included three de- 
stroyers, seven guided missile destroyers, three frig- 
ates, and two destroyer escorts. 

Demographic measures consisted of age, training, 
education, and tenure. 

The measures of perceived leader behavior {8) in- 

• support (extent to which the leader is aware of and 
responsive to the needs of subordinates); 

• goal emphasis (behavior that stimulates personal 
involvement in meeting group goals); 

• work facilitation (behavior that helps to achieve 
goal attainment); 

• interaction facilitation (behavior that encourages 
the development of close, mutually satisfying rela- 
tionships within the group); 

• planning and coordination (degree to which super- 
visors are able to plan and coordinate the group's 
abilities to achieve maximum performance); 

• upward interaction (degree to which a supervisor 
is successful in interactions with higher levels of 
command) ; 

• confidence and trust (group members ' feelings of 
trust and confidence in their supervisors). 


Two major relationships were expected and gen- 
erally supported by the analyses. 

First, individual difference measures indicated 
that significantly more job-related accidents and in- 
juries were experienced by younger, less educated, 
and inexperienced workers, regardless of division 
assignment. These characteristics were more com- 
mon in Deck than in Engineering Divisions. 

Second, perceived leader behaviors were related 
to accident and injury rate, over and above the influ- 
ences found for personnel composition among Deck 
Division workers. At the same time, leader behaviors 
were not related to injury rates for "M" and "B" 
Division personnel. A more detailed discussion of 
these findings has been presented elsewhere (9). 

These results suggested that complex interrela- 
tionships exist among individual, environmental, 
and organizational variables. In hazardous environ- 
ments, for example, little influence is felt from either 
individual or organizational factors, since environ- 
mental conditions regarding area safety are so 
pervasive. Thus, it appears that accident prevention 
in Engineering spaces may be accomplished more 
effectively by emphasizing greater environmental 
(i.e., equipment) protection, safety programs, etc. 

On the other hand, the critical variable in work sit- 
uations such as Deck Maintenance appears to be 
leader effectiveness in planning and organizing 
activities while at the same time maximizing avail- 
able equipment and manpower resources {10). 

It is important for ship officers and petty officers in 
certain high-risk divisions to become cognizant of the 
interrelated nature of task requirements, personnel 
characteristics, and leadership styles in their daily 
interactions with men from their own and other divi- 
sions and departments. In either Deck or Engineer- 
ing Divisions, these individual differences are impor- 
tant with regard to training and work experience. 
Thus, increased attention should be directed toward 
expanding the worker's ability to cope with the en- 
vironmental or organizational factors predictive of 


U.S. Navy Medicine 


Efforts by the Naval Health Research Center, San 
Diego, to explore the contribution of selected envi- 
ronmental, organizational, and individual factors 
associated with work-related accidents are dis- 

This research has indicated that the strength of 
association between environmental or organizational 
variables and subsequent accident rates is depend- 
ent upon the degree of hazard in the job, personnel 
composition, and leader behaviors. 

Finally, findings are discussed in terms of future 
programs directed toward increasing the worker's 
ability to recognize the most salient factors associ- 
ated with work-related trauma. 


1 , Surry J : Industrial Accident Research: A Human Engineer 
Appraisal. Toronto, Canada: Labour Safety Council, Ontario 
Ministry of Labour, 1974, 

2. Pugh WM, Erickaon JM, Jones AP: Worker's Perceptions 
of Safety as a Predictor of Injury, Report No. 76-75. San Diego, 
Calif.: Naval Health Research Center, 1976. 

3. Gunderson EKE: Organizational and environmental in- 
fluence on health and performance, in King BT, Streufert SS, 
Fiedler FE (eds) : Managerial Control and Organizational Democ- 
racy. Washington: V. Winston & Sons, 1977. 

4. Kleinman SD: Personnel Factors Associated with Naval 
Aviation Accidents, Report No. 76-1196. Arlington, VA.: Center 
for Naval Analyses, 1976. 

5. Gunderson EKE, Sells SB: Organizational and Environ- 
mental Factors in Health and Personnel Effectiveness: I. Intro- 
duction, Report No. 75-8. San Diego, Calif.: Naval Health Re- 
search Center, 1975. 

6. James LR, Jones AP: Organizational structure: a review of 
structural dimensions and their conceptual relationships with in- 
dividual attitudes and behavior. Organ Behav Hum Perform 16: 
74-113, 1976. 

7. Jones AP, James LR: Psychological and Organizational 
Climate: Dimensions and Relationships, Report No. 77-12. San 
Diego, Calif.: Naval Health Research Center, 1977. 

8. Jones AP, James LR, Bruni JR: Perceived leadership be- 
havior and employee confidence in the leader as moderated by 
job involvement. J Appl Psychol 60:146-149, 1975. 

9. Butler MC, Jones AP: Perceived Leader Behavior, Individ- 
ual Characteristics, and Injury Occurrence in Hazardous Work 
Environments, Report No. 77-50. San Diego, Calif.: Naval Health 
Research Center, 1977. 

10. La Rocco JM, Jones AP: A Systems Approach to Organiza- 
tional Functioning in the Navy, Report No. 77-25. San Diego, 
Calif.: Naval Health Research Center, 1977. 


Trichloroethylene Dangers 

Trichloroethylene (TCE) is a 
clear, colorless liquid with the 
"sweet" odor characteristic of the 
chlorinated hydrocarbons. Usually 
it is used as a degreasing solvent by 
metal fabrication shops, and in the 
production of waxes, gums, and 
pesticides. Specific uses range in 
complexity from "bucket" opera- 
tions, in which the solvent is used in 
small quantities to clean tools, to 
large mass-production degreasing 
operations provided with engineer- 
ing controls. 

Chemically, TCE is not danger- 
ously reactive; however, it does 
slowly decompose when exposed to 
light and water vapor, forming hy- 
drogen chloride gas and, at elevated 
temperatures, chlorine. Trichloro- 
ethylene may react with strong 
alkalies to form chloroacetylene 
and/or dichloroacetylene, which are 
very toxic and can be explosive. In 
addition, TCE may decompose on 

contact with certain metals, with 
open flames, with ultraviolet radia- 
tion, and during many welding 
operations, and may form phosgene 
and/or hydrogen chloride. Because 
of the slight decomposition that is 
possible with pure TCE, commercial 
grades usually contain stabilizers or 

TCE vapors can easily be con- 
trolled in systems that incorporate 
partial enclosure, temperature con- 
trol of the vapors, and/or local ex- 
haust ventilation. Whenever such 
controls are not effective, however 
— or when there is a need for open 
transfer of the liquid — the danger- 
ous potential for overexposure of 
workers to this material exists. 

Studies have indicated that TCE 
is absorbed rapidly by the lungs fol- 
lowing inhalation and is eliminated 
to only a small degree on exhala- 
tion. The outstanding characteris- 
tics of TCE overexposure include 

headache, dizziness, vertigo, trem- 
ors, and a feeling and appearance of 
light-headedness or drunkenness. 
These symptoms may progress to 
unconsciousness and, in some 
cases, death. Long-term illnesses 
include CNS depression, kidney and 
liver damage, and in some cases 
cardiovascular failure. 

• A physical exam, including car- 
diac, pulmonary, liver, and kidney 
examinations, should be made 
available yearly for persons exposed 
to TCE. BUMEDINST 6260.22 lists 
guidelines for the examinations re- 

• Handling and hazard-warning 
labels should be applied to TCE 
tanks or containers. 

• If local exhaust ventilation is un- 
available or is inadequate to remove 
TCE vapors, exposed workers must 
wear the approved NIOSH respira- 
tor (NSN 00-022-2524). 

— Adapted from the Pacific Health Bulletin 

Volume 69, May 1978 


A Psychiatric Nursing Care Plan: Total Care 
for the Patient in Military Psychiatry 

LCDR Diane K. Hoblitzell, NC, USNR 

Planning total nursing care for the hospitalized pa- 
tient is a central part of every nurse's education, but 
care of the psychiatric patient presents unique prob- 
lems. Yet all too frequently, in facilities where psy- 
chiatry is only a small part of the services offered by 
the hospital, nursing personnel may try to adapt the 
standard nursing care plan used in medical-surgical 
areas for use with psychiatric patients. As a result, 
crucial problems may often be missed; communica- 
tion among staff members about the patient's needs 
is inadequate ; corrective action for specific problems 
is not carried out; and a consistent therapeutic milieu 
is not established. 

In such circumstances, all that has been accom- 
plished is to temporarily remove the patient from the 
stresses he came from and put him in another envi- 
ronment. If we do not provide positive growth expe- 
riences for the patient and help him identify his prob- 
lems and find better ways of dealing with them, we 
have failed in treatment. 


At NRMC Jacksonville , the nursing staff devised a 
two-part psychiatric nursing care plan designed to 
ensure a consistent therapeutic milieu and a highly 
individualized treatment program. 

Part I of the plan (Figure 1) deals with the general 
nursing treatment of the psychiatric patient, includ- 
ing attitudes with which he or she is to be approach- 
ed, and appropriate therapies. It includes a number 
of patient-information items that are common to all 
nursing care plans, but deletes items that seldom, if 
ever, affect the psychiatric patient. In place of these, 

LCDR Hoblitzell was charge nurse of the Psychiatric Unit at 
Naval Regional Medical Center Jacksonville, Fla., from January 
1976 to December 1977. She is currently on inactive status. 

the form provides additional space, under "special 
instructions," where special-care requirements can 
be emphasized. 

The following items in Plan I are specific to care of 
psychiatric patients and require brief explanation. 

Special precautions. On admission, and periodi- 
cally throughout the hospitalization period, each pa- 
tient is evaluated by both the psychiatrist and the 
nursing staff as to suicide, "elopement" {escape), or 
other precautions required. This section of the 
nursing care plan enables staff members to see at a 
glance what degree of observation the patient re- 
quires at any point in his hospital stay. 

• "Suicide I" classification is ordered for all pa- 
tients considered high suicide risks. Precautions in- 
clude the following: 

1 . The patient will be in a restricted status on the 

2. The patient will be under constant 24-hour ob- 
servation, on the ward and in all scheduled activities, 
by ward Hospital Corps personnel. (This includes 
observation while the patient is shaving or using 
head facilities, and throughout the night.) 

3. Any seclusive or unusual behavior, or any at- 
tempts at self-harm, will be reported to the patient's 
doctor immediately. 

• "Suicide II" classification is ordered for patients 
considered to be lesser suicide risks. Precautions 1 
and 3 above apply, but the patient is under close, 
rather than constant, observation on the ward and in 
scheduled activities. (This includes observation of 
the patient while he is shaving and at 30-minute 
intervals around the clock.) 

• "Elopement" or other precautions required for 
individual patients should be ordered as indicated 
and noted on the nursing care plan. 

Privileges. The patient's privilege status is a 
major indication of his progress and ability to cope 


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with increasing responsibilities. At NRMC Jackson- 
ville, the progression of privileges is as follows: 

• Restricted status (ward privileges). During the 
initial evaluation period, each patient must remain 
on the ward in pajamas and robe. The patient partici- 
pates in all scheduled activities off the ward (e.g., 
occupational and recreational therapy) and keeps 
appointments in other areas of the hospital with a 
staff escort. He is not allowed visiting or telephone 
privileges, and he eats on the ward. 

• Hospital privileges. The patient may go to any 
area of the hospital building that is open to visitors 
and other patients . He must wear the uniform of the 
day — on or off the ward — from 0800 to 1600, after 
which appropriate civilian dress is acceptable. He 
may have telephone, visiting, and Red Cross privi- 
leges as desired, and must eat in the mess hall. He 
must sign in and out in the ward log, indicating his 
exact location at all times; return to the ward for pre- 
scribed medications and all scheduled activities; and 
be on the ward for the night by 2200. 

• Base privileges. The patient has the same privi- 
leges and responsibilities as with hospital-privilege 
status, except that he is also free to go to any unre- 
stricted areas on the base. 

• Class II liberty. The patient may leave the base for 
overnight on Wednesdays and weekends. 

• Class I liberty. The patient may leave the base at 
1600 each day for overnight. 

Liberty-status patients have the same responsibili- 
ties regarding hospital and ward routine as those 
with hospital or base privileges. They must remain 
near the ward during the day, but are given special 
consideration when they need to take care of 
personal matters— particularly if these are related to 
discharge planning and future goals. Liberty-status 
patients are also responsible for getting prescrip- 
tions for liberty medications filled and for taking 
their medications as prescribed. 

Once the patient has reached a Class I liberty 
status and has demonstrated ability to handle re- 
sponsibilities and cope with the realities of everyday 
living, he should be ready and able to accept dis- 
charge from the hospital setting. 

Therapies. Psychiatric patients improve more 
rapidly when their time is occupied: they should not 
be ignored or allowed to remain idle. Many of these 
patients have low self-esteem and lack the initiative 
and/or confidence that would prompt them to seek 
activity spontaneously. Therefore, the nursing staff 
endeavors to create a program of therapeutic value 
that will fill the patient's time. 

At NRMC Jacksonville, therapies offered include 

occupational, recreational, group, and individual 
therapy, as well as a work program. Each patient 
participates in all of these at some point during hos- 
pitalization. The nursing staff must be aware of the 
patient's progress in these therapies and be alert to 
needs for more encouragement or for individualized 

The nursing care plan clearly outlines for all staff 
members the types of therapy in which the patient is 
involved. Notations on specific areas of emphasis can 
further enhance a consistent team approach. 

Milieu therapy. Perhaps the most important ele- 
ment in providing a therapeutic milieu is a consistent 
approach to the individual patient. It is confusing to 
the patient when one staff member is overly solicit- 
ous while another shows little attention, or when one 
adheres strictly to ward policies while another inter- 
prets them loosely and gives the patient a great deal 
of personal leeway. Planning the approach to which 
the patient will respond most favorably is crucial in 
managing the overall hospital experience. 

The concept of "attitude therapy" was developed 
at the Menninger Hospital in Topeka, Kan., and has 
proved highly successful. At NRMC Jacksonville, 
the nursing staff has defined five different ap- 
proaches for attitude therapy. The approach to be 
used for a particular patient is ordered by the psy- 
chiatrist and adhered to by all members of the nurs- 
ing team. As the patient's needs change, the attitude 
prescription may also change. 

• "Active friendliness" is the attitude most fre- 
quently used with inhibited or withdrawn, schizo- 
phrenic or psychotic patients. This prescription re- 
quires that the nursing staff take the initiative in 
demonstrating caring, concern, and special interest 
in the patient. The quality and quantity of attention 
given to any patient at a particular time must be 
within therapeutic boundaries, but the nursing staff 
should always be ready to assist him, be aware of his 
whereabouts, and attempt to minimize withdrawal. 

• "Passive friendliness" is most often used with pa- 
tients with paranoid personalities or problems. This 
prescription calls for the nursing staff to maintain a 
"psychological distance," letting the patient take 
the initiative in building a relationship, and respond- 
ing to him in a therapeutic, friendly manner. Staff 
should not force attention on the patient, but brief 
contacts should clearly give the message that staff 
members are available to help when needed. 

Common courtesy and compliance with ward rou- 
tine should be expected of these patients. 

• The "matter of fact" attitude is prescribed pri- 
marily for patients with personality disorders— for 


U.S. Navy Medicine 





Dole Goal 




FIGURE 2: The plan— Part 

example, narcissistic or manipulative patients. 
Nursing staff should not take the initiative or get 
personally involved with these patients. They should 
maintain a casual, unemotional approach, without 
showing lack of interest. Direct reassurance should 
be avoided. 

• "Kind firmness" is the attitude prescribed for 
depressed patients. Nursing staff should direct their 
resources toward getting the patient to express 
anger. They should not sympathize, over encourage, 
or be swayed by the patient's complaints but, rather, 
always imply hope. The staff should convey a feeling 
of assurance that they know what is to be done. Staff 
should not challenge or be overbearing. 

Expectations of the patient should be stated di- 
rectly, clearly, and with quiet confidence, and the 
staff should make sure that the patient follows 
through. The doctor's order for this attitude should 
specify whether physical constraint is to be used in 
implementing it. 

• "Reality encouragement" is the attitude often 
prescribed for confused patients. This is a nonjudg- 
mental approach: the nursing staff does not inter- 
pret, but simply points out reality to the patient— 
including attention to such basic physical needs as 
eating, elimination, etc. 

Specifying the prescribed attitude approach on the 
nursing care plan eliminates guesswork by staff, 
gaps in communication, and inconsistency of treat- 
ment. It is, of course, crucial that all staff members 
fully understand the definitions and concepts behind 
the attitude prescriptions, and the methods by which 
they should be implemented. 

The nursing staff must be involved in the continu- 
ing evaluation of prescribed approaches and should 
have a voice in recommendations for any needed 


We have been discussing general nursing treat- 
ment of psychiatric patients ; however, these patients 
may exhibit a variety of individual problems that 
nursing staff should recognize and work with. Part II 
of the Psychiatric Nursing Care Plan (Figure 2) was 
developed with this in mind. 

The section of Part II on problems, goals, and ap- 
proaches should be started after initial evaluation of 
the patient for four or five days following admission. 
In this section, the nursing staff should clearly iden- 
tify individual problems that come to light. For ex- 
ample, the patient may be having trouble with eat- 

Volume 69, May 1978 


ing, sleeping, or elimination. He or she may be ac- 
tively hallucinating or delusional. There may be 
problems with low self-esteem, or difficulties in in- 
terpersonal relationships. Family problems may 
impede the patient's progress and need to be dealt 
with, etc. 

For each area of difficulty identified, the staff 
must establish goals to work toward; then develop 
practical approaches for reaching them. Indeed, this 
problem-solving effort is the area of greatest chal- 
lenge in psychiatric nursing care: the area where the 
staff focuses its resources to work for the rehabilita- 
tion of the patient. 

Notations in this section of the nursing care plan 
must be concise and specific: the various members of 
the nursing team, changing from shift to shift, must 
be able to look at the plan for a particular patient and 
know what areas to concentrate on. Once a problem 
has been eliminated or a goal attained, Part n should 
be dated in the appropriate column and substantia- 
tion provided in the nursing notes for that date. 

The second section of Part II involves planning for 
the patient's discharge. 

From the first day of the patient's hospitalization, 
the nursing staff should have in mind the objectives 
to be met prior to discharge. These objectives, as 
stated in the nursing care plan, should outline what 
the staff expects to accomplish with and for the pa- 
tient during the hospitalization period. They should 
include the patient's better understanding of his ill- 
ness, understanding of any medications to be taken 

after discharge, and demonstration of better coping 
mechanisms in specific problem areas. 

The discharge objectives are an essential part of 
the nursing audit, and documentation that they have 
been reached must be retrievable in designated 
areas of the patient's chart. More importantly, 
though, a clear statement of the discharge objec- 
tives, made at the start of the patient's hospitaliza- 
tion, gives the nursing team a rehabilitative focus to 
work toward throughout his stay. 


The psychiatric patient presents specific problems 
and needs, requiring a special type of treatment by 
trained individuals. Unless nursing care during hos- 
pitalization is carefully planned, no more will have 
been accomplished for the patient than to temporar- 
ily remove him from the stressful situation that pre- 
cipitated his hospital stay. 

Psychiatric hospitalization itself is stressful; how- 
ever, a carefully controlled environment, appropriate 
therapies, a consistent approach, effective problem 
solving, and thorough discharge planning will pro- 
vide maximum benefits to the patient from his hos- 
pital stay— and shorten its duration. 

The Psychiatric Nursing Care Plan, Parts I and H, 
provides both an invaluable form of communication 
among staff members and a total nursing treatment 
plan directed toward a successful outcome for the 
hospitalized psychiatric patient. 

Notes from the I.G., Medical 

Following are some common 
problems identified during recent 
command inspections: 

• JCAH accreditation. Cardiopul- 
monary resuscitative training of 
physicians, nurses, and allied 
health personnel in the Emergency 
Services area is required and should 
be documented. 

• Loss awareness program. The 
national average of losses in civilian 
hospitals from all causes (theft, fire, 
lost time, etc.) has been estimated 
at $1,400 per bed per year. If this 
figure is accurate, the Navy health 
care system is suffering losses in 
excess of $16 million per year. 
Everyone involved in health care 
must be aware of loss and protect 

diminishing dollar resources. 

• Policy/procedural manuals. A 

written policy /procedural manual is 
to be available in all patient care 
areas of branch clinics and naval 
regional medical centers to guide 
personnel in performance of duties. 
Specific infection control and safety 
policies are to be incorporated, and 
the manuals should be dated to indi- 
cate the time of formulation, review, 
or revision. 

• Medical records. Authentication 
of entries in medical records must 
be dated and must identify the in- 
dividual as to Corps or civilian title. 

Emergency records must include 
the condition of the patient on re- 
lease and instructions to the pa- 

tient/parent regarding medication 
and when or under what circum- 
stances to return for followup. 

Personnel authorized to accept 
and transcribe verbal orders must 
be identified in medical staff by- 
laws or rules and regulations. More- 
over, the medical staff should de- 
fine those verbal orders that must 
be authenticated by the responsible 
medical officer within 24 hours. 

Discharge summaries must in- 
clude information relative to the 
condition of the patient upon dis- 
charge, medication, any special 
diet, level of activity that may be 
performed, and when to return for 
followup care. 
—Roger F. Milnes, RADM, MC, USN 

U.S. Navy Medicine 



Occupational and Preventive Medicine 
Division of BUMED is seeking a pri- 
mary-care medical officer for assign- 
ment as epidemiologist to Navy Envi- 
ronmental and Preventive Medicine 
Unit No. 7, Naples, Italy. The candidate 
would be trained on the job by the offi- 
cer in charge, who is board certified in 
preventive medicine and is an experi- 
enced epidemiologist, and by the unit's 
allied science professionals. The posi- 
tion involves considerable travel in 
Europe and the Mediterranean area and 
will be open in the summer of 1978. Fol- 
lowing this tour, interested physicians 
would be encouraged to enter an 
M.P.H. program and training for board 
certification in a preventive medicine 
specialty. Interested officers should 
write or call CAPT D.F. Hoeffler (MC), 
Director of Occupational and Preventive 
Medicine at the Bureau of Medicine and 
Surgery (Code 55); Autovon 294-4620 or 
Commercial (202) 254-4620. 


Naval Health Sciences Education and 
Training Command (HSETC) will host 
an operational medicine workshop 12-15 
June 1978 at the Holiday Inn, Embar- 
cadero, San Diego, Calif. Purposes of 
the workshop are to review the present 
state of operational medicine training 
and practice, identify specific deficien- 
cies and problems, and recommend 
steps to overcome them; recommend a 
general system of operational medicine 
training; recommend a pathway for 
career training in operational medicine; 
and partially formulate curriculum out- 
lines for selected operational medicine 
training programs. 

Findings and recommendations of 
workshop participants will be consoli- 
dated by HSETC and later made avail- 
able on request. 


Navy Dental Corps researchers have 
been collecting data on long-term re- 
sults of maxillofacial casualty treatment 
since 1968. Emphasis has been on eval- 
uating reconstructive and rehabilitative 
procedures to determine the effective- 
ness of cosmetic and functional results. 
A textbook, Management of War In- 
juries to the Jaws and Related Struc- 
tures, based upon data from this study, 

is to be published this year. Collabora- 
tive studies are being developed with 
the National Academy of Sciences medi- 
cal followup agency and the Veterans 
Administration to investigate the psy- 
chological impact of oral-facial injury 
and treatment. 


investigators at the National Bureau of 
Standards, Gaithersburg, Md., are 
working to resolve problems associated 
with various dental restorations that re- 
quire casting metal into molds. Non- 
precious and semiprecious metals that 
could replace costly gold are being 
studied. If these metals prove to be the 
equivalent of gold in fitting and wear 
characteristics, and if they are shown to 
have the same biological acceptance, 
they could help Navy dentists to provide 
their patients with high-quality, low- 
cost crown and bridge prostheses. 


The Naval Health Sciences Education 
and Training Command has established 
a Department of Operational Medicine, 
with CAPT Bythel D. Dutton (MC) as 
first director. 

The primary objective of the new de- 
partment is to develop, manage, exe- 
cute, and administer general and cate- 
gorical operational medicine programs. 
Specific goals are: 

• To develop and execute require- 
ments-based education and training 

• To provide Medical Department per- 
sonnel with the technical, scientific, and 
managerial skills and knowledge which 
they need to perform in operational 
medicine billets. 

WARNING . . ■ Recent information from 
the Office of the Surgeon General of the 
Air Force defines a possible problem, 
involving "composite fiber phenome- 
non," that may be encountered by 
medical personnel involved in the inves- 
tigation of aircraft mishaps of certain 

Composite fibers are strands of 
carbon- or boron-coated tungsten that 
typically are imbedded in an epoxy 
matrix to produce a material of superior 
structural properties, where high 
strength and light weight are important. 
When this material is burned or im- 

pacted, the fibers may become air- 
borne. If they achieve contact with 
electrical components of power stations, 
generators, computers, etc., they can 
cause arcing, electrical short circuits, 
and systems failures. Accordingly, a 
warning is directed to personnel re- 
sponding to any accident scene involv- 
ing aircraft with composite structural 
members. Inhalation, contact, or other 
health hazards do not appear to be sig- 
nificant because of the predominantly 
large particle size involved. 

The unclassified code name "CORK- 
ER" is used to denote mishaps involv- 
ing aircraft in which composite fibers 
are a part of the aircraft structure. 

previously unrecognized pathologic de- 
fect has been discovered by investiga- 
tors at the Armed Forces Institute of 
Pathology. The disease — myo-adenylate 
deaminase deficiency — was discovered 
following development of a new histo- 
enzymatic stain by Dr. William N. Fish- 
bein, chief of the AFIP Biochemistry 

The stain has been applied to all fro- 
zen muscle biopsies received at AFIP, 
with myo-adenylate deaminase deficien- 
cy indentified in six specimens. The pa- 
tients have a history, often since child- 
hood, of muscle weakness or cramping 
after exercise. Muscle biopsy shows 
minimal or no pathologic changes other 
than absence of the enzyme. All cases 
were verified by solution assay of 
muscle biopsy homogenates. 

AFIP researchers believe the disease 
is fairly common and may account for a 
large percentage of patients previously 
diagnosed as having benign congenital 
hypotonia or nonprogressive congenital 
myopathy. The diagnosis of myo- 
adenylate deaminase deficiency may 
have been missed in the past because 
patients' muscle histology and red cell 
enzyme level were normal. A descrip- 
tion of the disease and its implications 
for muscle physiology will be published 
shortly in the journal Science. 

AFIP can carry out a full battery of 
histoenzymatic stains, fiber type and 
size histograms, and solution assays. 
The Institute invites physicians to sub- 
mit muscle biopsies for any patients 
suspected of having myo-adenylate 
deaminase deficiency. 

Volume 69, May 1978 

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